310164_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: O Com Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: 7 Arrival Time: Departure Time: o County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: f2 --c— G -.—
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: at 7 k P
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current Design
Wet Poultry C►apacity Pop. Cattle Capacity
Layer IDairy Cow
Current
Pop.
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
eeder to Finish
L 7Z
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
Dr. l;oultr, C_a aci_ P,o Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
L
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑i - off❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑Other;
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
[3 NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3 o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesEJ'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

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

Facili Number: - Date of inspection: 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ -M-o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below. o
❑ Failure to complete annual sludge survey ❑Failure to develops-POA fors '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 tosecure a p9osphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Io �❑ NA ❑ NE
❑ Yes ❑ No iA_❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes Q' loE❑ NA ❑ NE
❑ Yes CD 5o I__I NA ❑ NE
❑Yes
[JITo7❑NA
❑NE
❑ Yes
C3-lqo--
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
Reviewer/inspector Signature: Date: ' 7 f %
Page 3 of 3 21412015

' ivi9ion�of w,-1 er Resources
,� �acllity Nutnber ©- G Y ©Division of Soil and Water Conservation
- Q Other�Age�neY -
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: 0"Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I �, �I Arrival Time: Departure Time: 1 D i1 5` County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: n
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
W,et Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
Dairy Calf
eeder to Finish
67!
75
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P�oult ,
Ca _aci_
Pao ,
Non -Dairy
Farrow to Finish
I
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
INK
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 ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
❑ Yes
0'7%._
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili N ber: 7 - 6 Date of Inspection: ne
WaMe Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-lqo_ ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,❑No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes fNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Q No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �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 DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O-No ❑ NA ❑ NE
maintenance or improvement?
L Is there evidence of incorrect land 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 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): Ot'/',.,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E�r_No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�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
[a -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ -Nb
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑-hlo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:a -No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ER 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: : - Date of Ins ection-
24 .Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes 0"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D-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 []-Ro ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No f3­NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [!I No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes F/INo ❑ NA ❑ NE
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes [n—No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes []"No
❑ Yes [No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any:additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary)...
C�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (O T 1 17�ay
Date: / /Y lla
21412074

rype of Visit: C Poiance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Zz Arrival Time: Departure Time: Z 5 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: �'� �' e r 4 d Integrator:
Certified Operator: Certification Number: �r'09y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DaiEy Cow
Wean to Feeder
Nan -La er
I
Dairy Calf
eeder to Finish Z3fGb
Dr. P,outt .
ILayers
Design
Ca aci_
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Lavers
Beef Feeder
Boars
1pullets.
Beef Brood Cow
Turkeys
Other Turkey Poults
Other 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 [/NNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: 7 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'L- -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3'go
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [i -?To
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as requited by the permit? ❑ Yes �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 ETNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes hlo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EnfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
IT 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
Fa<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[rNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ErNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: f3 I - Date of Inspection: R2 / 3—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes I__I 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 EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes • E�C:) NA ❑ NE
or
Other Issues
28. Did the facility fail to properly dispose of dead animals With 24 hours and/or document ❑ Yes Ef'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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?
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[-]Yes [!fNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
--N-o ❑ NA ❑ NE
[fNo ❑ NA ❑ NE
Date: G/2 4
21412014

77
Type of Visit: JO Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 12moutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �^ / Arrival Time: /0.' eparture Time: County: / J[��I /yam Region: �lAp
Farm Name: ✓ S Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: Integrator: A-;,, d
Certified Operator: Certification Number:
<ID
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity P.
Wean to Finish La er
Design Current
Cattle Capacity P.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
-apaci P,o ,
La ers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkcy Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: y
❑ Yes )Z'No ❑ NA ❑ NE
a. Was the conveyance man-made? [—]Yes PkNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes E5—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 21 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes if No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �2 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection: 2
Waste Collection & Treatment
4. Ts storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes k] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes E:fNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 6 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Pj "No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
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 6No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No
0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ff 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 ,0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E�J`&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. 40
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LM 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
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
0 NA
❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2-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 P No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �^ o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes j2nNo
❑ 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 L'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 ET -No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes O'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 E3-No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes J�fNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ;2rNo
❑ NA ❑ NE
Comments (refer to question #1): 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).
Reviewcr/Inspector Name: J-0011K PLGt _ 1110A 7 [L
Reviewer/Inspector Signature: Z'
Page 3 of 3
Phone:
Date: �lZ—IZ
1214,11011

Type of Visit: k] ompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: f"Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Z Z Arrival Time: 11.2 iQQ eparture Time: County:��Ol1/^I_tegion: Qom,
Farm Name: J6. 1r_---_ -_ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: Z/
Certification Number: -
Certification Number:
Longitude:
Design C►urrent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pap.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Dairy_EE Calf
Feeder to Finish
Da Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D , P�oult , Ca aci_ P,o
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other �: �'
Turke s
Turke Poults
Other
Discharizes and Stream Impacts
1. Is any discharge observed fra�i 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 ,4fT No ❑ NA ❑ NE
❑ Yes jallo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes P�No
[:]Yes �- o
[-]Yes 2] No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: Z Z
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 1 Structure 2 Structure 3 Structure 4
Identifier: " -2—
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P - 5
❑ 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 ;2No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
_P
❑ Yes C2-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ErNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes e 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
0 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 _1�3­No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes in —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 LNo ❑ NA ❑ NE
❑ Yes � No ❑ NA El NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes _LA -No
❑ 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 _Lq-No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes E7 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes VrNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of —Inspection: ZZI
VI
24!Did the facility fail to calibrate waste application equipment as required by the permi .
❑ Yes.0
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
P(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
J�fNo
❑ 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
;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
2rNo
0 NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
JZ-No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
PrNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
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
�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
eNo
❑ NA ❑ NE
e
Reviewer/Inspector Signature: `� Date: 2-2 / f
Page 3 of 3 214 1r

I�
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit:ey Zoutine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: rE' Departure Time: County: 04Region:
Farm Name: r/n �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cattle
DairyCow
Design Curr ent
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Design Current
DairyHeifer
D Cow
Farrow to Feeder
Farrow to Finish
I) . P,oult , Ca aci P,o ,
Layers
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharizes 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,,fn No ❑ NA ❑ NE
❑ Yes 21 No
❑ Yes P�rNo
❑ Yes No
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412011 Continued

Facility Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )Z�4o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes ,C3"No [DNA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes XNo ❑ 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 )�fNo
❑ NA
❑ NE
8. Do any of the structures 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 [� o
❑ NA
❑ NE
maintenance or improvement?
TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, "check the appropriate box below. ❑ Yes ❑ No
❑ NA g3WE
❑ 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 J:21NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA EJINE
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [:)No ❑ NA J2"NE
❑ Yes ❑ No ❑ NA �
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ej No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E� No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )a 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 ETNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: Date of inspection:
24. Dial the facility fail to calibrate waste application equipment as required by the pe ? ❑ Yes ;]If(o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes j�No ❑ NA ❑ NE
[—]Yes [/�' No ❑ NA ❑ NE
❑ Yes r❑ No ❑ NA J2 NE
[:]Yes ❑ No ❑ NA,.[5'NE
❑ Yes ENo ❑ NA [] NE
[]Yes [—]No ❑ NAJ:�FNE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 12-No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [] Yes ONo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ;2-Ko ❑ 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).
2,73
Reviewer/Inspector Name: Az wk
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �/� �z
010 Date: 1/12
11412011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Is Arrival Time: / G jQeparture Time: County:
Farm Name: _-- 2- 6z G [Q dL-,, trs r-r►--f _ Owner Email:
QJ
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: SL
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
Ca acity P,o ,
D Cow
Farrow to Feeder
Farrow to Finish
D , P,oult ,
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
OtherI
Other
Turke s
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes _L�FNo
❑ 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 ;2'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 [Et`&o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes 10 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,E�fNo ❑ 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: 2, =s
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): cei-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes '0 No ❑ NA 0 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 2-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No
❑ NA
Q E
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [:]No
❑ NA
(2,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
[3-NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No
❑ NA
LaNE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA
,�_=j 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 n 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?
❑ Yes P-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA JaNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA 0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes _jErNo ❑ 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
❑ 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 ,E] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - L Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
, o
❑ Yes/N
NA NE
❑ ❑
25: Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes allo
❑ 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 structurc(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 L-No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ,❑'No
❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes .0 No
C] 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 051jo
❑ NA L2'5E
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes L:].hTo
[] 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 �2 E
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes I "No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes gNo ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinns of facilitv to better explain situations fuse additional naLves as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: .20
121416011

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I �/23/// I Arrival Time: eparture Time: County: Region:.
Farm Name: SL5 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = n = i = LL Longitude: = o = 6 = u
Design Current Design Current Design Current
Swiue Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
❑ Ciits ❑ Non -Layers
❑ Boars El Pullets
❑ Turkeys
Other ❑ Turkey Pouets
❑ Other I IEJ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cowi
Number of Structures:
DischarEes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes J20No ❑ NA ❑ NE
El Yes
❑No
[I NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes 13'No
El Yes
T-''�
❑NA
El NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�rNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
VNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ErNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
,.,/
L,�'No
El NA El NE
through a waste management or closure plan?
✓✓✓
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
[]NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
/No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
VNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[No
El NA [I NE
maintenance/improvement?
/
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ElNA ElNE
ElExcessive Ponding ElHydraulic Overload [IFrozen Ground [IHeavy Metals (Cu, Zn, etc.)�'No
❑ 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 . [;io
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/PT o
[I NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
1a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
ElNA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1Vo
❑ NA
❑ NE
Comments (refer to question #} ;NEzplaiii any YES answers and/or any recommendations or any ather mmenti»
Use` drawings of facility to:better explain s�tuatuins {use additional pages as necessary) = >. _Y
AL
Reviewer/inspector Name Phone: �6
Reviewer/Inspector Signature: Date: 0Zg
3 /
Pa e 2 of 3 I2128104 Continued
6

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P7No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 7j-' No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O'No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �D No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? Oyes 14 No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes )6No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ONo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 2rNo ❑ 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 LZNo ❑ 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 WNo ❑ 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 P No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes o ❑ NA ❑ NE
Additional Comments and/or Drawings; x
WA -/U
3 6 �
" jhuasc sr�r✓e�o� ao/U
31%l
I 1 Lo//j
/7 y
5�k� w �f�• 19re, -�J- Mr��-- l� h-e � 5
O/V 1.3 P
j' lt�r A
Page 3 of 3 12128104

A
Type of Visit ^O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visi;,�Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 Q Arrival Time: rQ G Departure Time: County: Region:
Farm Name: J S �/%�� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: _ -1 • Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = f 0 is Longitude: = ° = ` = "
Design Current Design Current Design
Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity
Population
❑ Wean to Finish
IEJ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish ❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder ElNon-Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
❑ Gilts [3 Non-Laers ❑ Beef Feeder
❑ Boars ❑ Pullets
El Beef Brood Co
El Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other I umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
rNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No . ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
WNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ONo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

i
Facility Number: Date of Inspection o
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 VNo ❑ 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 CZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0No ❑ 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
T Do any of the structures need maintenance or improvement? El Yes IQ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [;J'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �' o ❑ 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 ET No ❑ NA [I NE
17. Does the facility lack adequate acreage for land application? ❑ Yes L]'No ❑ NA ❑ NE
18, Is there a lack of properly operating waste application equipment? ❑ Yes o ❑ NA ❑ NE
'Comments (refer to..question #) Explain any YES ansv`eirs and/or any reeomntendations or anV other comments r
.Use drawings ©f facility to eater explain situations. (use•additional pages as nec ): "' -# �"
g h ti, essary)'
s Gvr/ �.,4 i A 51A4P W Ae, av! O
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature: 66 / 6--, Date:
11128104 Continued

r
Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ W CJP El Checklists El Design El Maps El Other
❑ Yes
'Q o
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Pno
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 °
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 2TNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �io
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �No
[:1 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 Pmo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes PNo
❑ NA
❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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? (iel 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?
Additional Comments -and/or Drawings.m" 4'
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
YJ No
❑ NA
❑ NE
❑ Yes ['No ❑ NA ❑ NE
1V28/04

Facility, Numbers
Q D visinn•i
Q Dtvisioi
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: Arrival Time: arture Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �e
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = 0 0 { = Longitude: = n = 6
Q D visinn•i
Q Dtvisioi
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: Arrival Time: arture Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �e
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = 0 0 { = Longitude: = n = 6
Desi n:.
g
Current Desr nk Cren'Curr:.ent
g.. a n�
Swine
Ca act
P, h-
o ulatton att a „�.
ro ulation Vet Poult ,Ca aci �P '' `.� =
p_ p ty,
Capac ty
Population.
- w. R .. W
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
d ❑ Non -Layer I
I
Dairy Calf
ElFeeder to Finish
f �m " '�
El Dairy Keifer
❑ Farrow to Wean
❑ Dry Cow
El Farrow to Feeder
❑ Non -Dairy
❑Farrow to Finish
❑ Layers
❑Beef Stocker
ElGilts
Non -Layers
❑ Beef Feeder
❑ Boars
=
❑ Pullets
❑ Beef Brood Cowl
I
—��
`
❑ Turkeys
- Other
❑ Turkey Poults
❑ Other
❑ 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?
❑ Yes �No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Date of Inspection
Facility Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA ❑ NE
//�
a. If yes, is waste level into the structural freeboard?
❑ Yes No
El NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure/5
Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 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 KNO
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Ye5 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 ZfNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
ElNA ElNE
maintenancelimprovement?
16
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
10
❑ 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
C
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes KjfNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ YesoNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Ye� No
❑ NA
❑ NE
Reviewer/Inspector Name Phone: /
Reviewer/Inspector Signature: Date:
Page 2 of 3 1212810 Continued

1[iacility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ "p ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes V(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 1�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ZNo
❑ 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 ,8 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 [ Xo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0No
❑ 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
J2<o
❑ 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
JdNo
❑ 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
jZfNo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA ❑ NE
Additional Comments and/or Drawings:
c�1�6 �ov� �008,
�V
l /
12128104

'division of 'Water Quality
Facility Number O Division of Soil and Water Conservation
- - - _ — -- — „ O,Other Agency
Type of Visit I'irompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit .Routine OComplaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: /
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: e_ a
Certified Operator:
Back-up Operator:
Location of Farm:
- Design -
Swine `Capacity';'-
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ ^Other
Owner Email:
Phone: �.
Phone
No:
Integrator: `�
Operator Certification Number:
Back-up Certification Number:
Latitude: E—] o E:�] Longitude: [� o =
Design Current Design Current
Wet-.Paultry ' `Capacity Population Cattle Capacity" Population
❑ Layer
❑ Non -Layer
'7_ -7
Dry Poultry ;
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: Ell
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 #-6, C41 Date of Inspection `l
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: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift []Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain, any YES answers and/or any. recommendationsorany other comments
.Use drawings -of facility to•better explainsituations. (use additional'pages as;necessary): v:
Reviewer/inspector Name I -6', t j I k-'_ �i� u� 1 , I Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 I2/28104 Continued

Facility Number: — Date of Inspection 1
ReAuired 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 ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
� y
I21,28104

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4:�`Routine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I
Q Arrival Time: i Departure Time: County:
C_ J
Farm Name: — Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: r:54ze
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator
Operator Certification Num er:
Back-up Certification Number:
Region: V
Latitude: [= o = 0 « Longitude: = ° =,
n Current
r@=apAacityjP"70—P—j1Ii91tion
Design Current
Design Current
Swine
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
I
I
❑ Dairy Calf
Feeder to Finish 1.-7:L
O
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
E]Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Disc_ homes & 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 J:3No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes Z No
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
LI No
❑ 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 ErNo ❑ 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 O No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes J:jNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 3No ❑ 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 43 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Jam] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) L(n�///
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ErNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ETNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes a No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0"No ❑ NA ❑ NE
❑ Yes ❑-No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other` -comments.' W ..
Use drawings of facility to better explain situations. (use additional pages as necessary):
T
Reviewer/Inspector Name Phone: /- 7,52
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Fa6lity Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J3'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EfNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [],No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
j3No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�] No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J2 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[DNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ &o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[I Yes
E] 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
RNo
❑ 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
O 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
[TNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
El"No
❑ NA
❑ NE
Additional Comments and/or Drawings:
I�
%
pi"
Cd��S
AL
r
Page 3 of 3 12/2VO4

Type of Visit � 5 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit .,O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: / r
� Departure Time: County: Ac, Region:
Farm Name: , S_� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: ,�c�e [ter Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
eede�sh
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: = o = Longitude: = o = = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Other
❑ Other _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes J'No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes -dNo
❑ NA
❑ NE
❑ Yes <0
❑ NA
❑ NE
12128104 Continued

Facility Number: — & Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes aNTo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O-No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V fain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
D i A
❑ NE
❑ Yes -1Vo
❑ NA
❑ NE
❑ Yes 2—No
❑ NA
❑ NE
❑ Yes _P110
❑ NA
❑ NE
❑ Yes JEDNo
❑ NA
❑ NE
❑ Yes
21�o
❑ NA
❑ NE
❑ Yes
2Wo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
2rNo
❑ NA
❑ NE
❑ Yes
[�[No
❑ NA
❑ NE
❑ Yes
J'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
r 2c-s-e, k1 cua, G Yt e rz�t n 5v`O � per
GU Foul] LIL
�frn S
12128104

Facility Number: j Date of Inspection 0
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:
❑ Yes '�] No
❑ Yes ❑ No
Structure 5
❑NA [I NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): ZZ _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes O"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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �3No _ ❑ 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 P No ❑ 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 j2rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
12 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes
D NO
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
o uera d 1 fcrlyl r'S
- 'o irepa o lr' low a r emS
❑ Yes J'No ❑ NA ❑ NE
❑ Yes ;:LNo ❑ NA ❑ NE
%*'t ood- Shame, �eCofd's AeQ4- d'c)d-cad/t_5
Reviewer/Inspector Name )Phone:
Reviewer/Inspector Signature: /G Date: !� 0�
12128104 Continued

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
of O erational Q Below Threshold
Permitted 13 Certified Q Conditionally Certified 0 Registered Date Last OperatedAr Above Threshold:
............ .....
Farm Name: ..... County:S621f >/
OwnerName:............................................................... Phone No:.......................................................................................
FacilityContact: ....... --1. ��.1�...... ............ Title: .......... �............................................. Phone No:....................................................
MailingAddress: ............................................................�......................................................................................................................_............................. ...........
Onsite Representative: ,�,',, 4V-t Integrator:............MEE ........................... ............................... .1............
Certified Operator: .............................................. .. Operator Certification Number:..................... .
Location of Farm:
t14wine []Poultry []Cattle []Horse Latitude �• �+ « Longitude ��• ' �•
Design Current Design Current Design . Current
Swine .Capacityacity Population Poultry Capacity Population ulation Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish ID Non -Layer ❑Non -Dairy
❑ Fiirrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total DeSigll Capacity
❑ Gilts
❑Boars _TotatSSLW;�•J
Number of Lagoons z ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding Ponds / Solid Traps '� , ❑ No Liquid Waste Management System t
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a.. If discharge is observed, was the conveyance man-made? . El Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) 0 Yes ❑ No
c. If dischar-e 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 o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
01/01/01 Continued

I
IFaciGty Number: � J� I— I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
identifier: ................................... .......................... ..........................
Freeboard(inches) ............�............................................................................................... .......................
..._...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
k(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?
XYes-6o&
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
I(
I(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
JNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop typeIA)A—-W SC.-4
13. Do the receiving crops diffe with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XXo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
&No
b) Does the facility need a wettable acre determination?
❑ Yes
KNo
c) This facility is pended for a wettable acre determination?
❑ Yes
_ o
15. Does the receiving crop need improvement?
❑ Yes
`�io
16. Is there a lack of adequate waste application equipment?
❑ Yes
o
eet o t e spray re un
Required Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil s
22. Is facility not in compliance with any applicable setback criteria in effect at the time of de
23. Did the facility fail to have a actively certified operator in charge?
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
26. Does facility require a follow-up visit by same agency?
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
❑ Yes d'No
❑ Yes XNo
❑ Yes �o
❑ Yes Mo
❑ Yes ( (No
❑ Yes XNo
❑ Yes fNo
o
❑ Yes
❑ Yes gNo
❑ Yes 'qNo
29. Are there any dead animals not disposed of properly within 24 hours?
01/01/01
❑ Yes YNo
Continued

I�
Facility Number: Date of Inspection 3
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not Iocated near the liquid surface of the lagoon?
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Printed on: 1/4/2001
❑ Yes. X'No
❑ Yes X-0
❑ Yes. No
❑ Yes o
❑ Yes Ai0
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
01/01/01

•
Type of Visit G Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency NNoo�t`ifiic�atitionn�� 0 Other Denied Access
Facility Number fate or visit: Time: E'
Not Operational 0 Below Threshold
IMPermitted © Certified O Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: 55g 71 County lvkak1H
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: Phone No::
Onsite Representative: l ntegrator: — U !► t/
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0. 0 " Longitude 0' 0 0 u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes CS�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? ElW Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �gNo
Waste Collection & Treatment �{
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway ❑ Yes t�l No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches):
05103101 Continued

Facility Number: j — G
Date of Inspection I EEZZO
5. Are there any immediate threats to the integrity of any of the structures observed?.(ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ® No
❑ Yes [gNo
❑ Yes C&No
❑ Yes [R No
❑ Yes C&No
WasteAuplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes RNo
11. Is there evidence of over application? / ❑ Excessive Pondin/g ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type ��lsnrG/lL l�'� 77 z �CYz)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes CSNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes E&NO
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
59-No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
M No
Reaui_red Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
tp-No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
21No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
153-No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
C,No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ER No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
P4 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
CO -No
M No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Comments (refer to question #) .:Explain $riy YES answers "&or.any recommeadatiotis or any.other otaoaents ;
Use drawings of facility to better explatii situations:`(ose additional pages'as necessary) ," ❑Field Cory ❑Final Note
e-,6 rAol Z019 46 10 oif I
Reviewer/Inspector Name `-
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: 3 — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below El Yes K 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 14�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑Yes No
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes WNo
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 9 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,bN"o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Elgv Yes Q o
Additional Comments and/or Draw•inIgs:
05103101

.. :.. ater Quality
0 Drvlsowand Water Conservation'
>.
Othei�.Agency-
E
fVisi#GoatF5liance Inspection O Operation Review O Lagoon Evaluation
for Visit outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: iine: Printed on: 7/21/2000
Q of Operational O Below Threshold
ermitted © Certified © Conditionally Certified Q Registered Date Last Operated Above Threshold:
Farm Name ......... County: ... .. �l�lG .......................
OwnerName:........................................................................................................................... Phone No:......................................
Facility Contact: .......... Title:.............. Phone No:
.........................................................................................................................................................................
MailingAddress:................................................................................................................. ..........................
......... ; ...... _
?5
Onsite Representative:. .ill..-l. integrator
Certified Operator: Operator Certification Number:
Location 'of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��«
Design Current ' . DesignCurrent Desi Sn Curreat
Ca aci - Po ulation
Wean to Feeder
er to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Poultry Capacity oCattle
Ca a -
.' Pv 6ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
.Namber. ,oi oasts . f ❑Subsurface Drains Present Lagnan Area ❑Spray Field Area
a Holding Poddi / Solid Traps' ❑ No Liquid Waste Management System
Discharges & Stream Imgacts
1. Is any discharge observed from any pan of the operation? ❑ Yes VNo
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
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: . .Z..../...............................................................................................................I...................... Freeboard (inches):
5100
❑ Yes
❑ No
.21zff--
❑ Yes
❑ No
❑ Yes
�No
❑ Yes
liNo
❑ Yes No
Structure 6
Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any imi late threats to the integrity of any of the structures obse ed? (ie/ trees, severe erosion, ❑ Yes h;�o
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? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste AppAication '
10. Are there any buffers that need maintenance/improvement? ❑ Yes 4No
11. Is there evidence of over a lication? ❑ Exc sive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes drNo
12. Crop type � V V � D ti E
i
13. Do the receiving cropsidiffer wit4 those designated in the Certified Animal Waste Management Plan (CAWMI
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required- Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (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?
io-vi61466fis :or- d01cWhdt,9 -were noted d ...ing this:visit: - YJo WHI -i-eeeiye iio further - : - -
correspondence.A"fth>is visit: - -' -' -'
ats (refer to question #): Explain any YES answers and/or any recom
wing.s.of faciliijto better explain situations. (use addi6o ial pages as E
V)
vI'L&
Ylivl nv.e.A � ✓"
❑ Yes (Vf No
[]Yes PNo
❑ Yes jNo
o
[]Yes
❑ Yeso
❑ Yes 9'No
❑ Yes No
❑ Yes Ex No
❑ Yes kNo
❑ Yes �(No
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes �I No
lations oir any other cominents. = }
I,J­ wct 0
A,
Reviewer/Inspector Name
Reviewer/Inspector Signai
Date: / > ,/ / e

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 ;Wor below ❑ Yes PNO
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
28_ Is there any evidence of wind drift during Iand application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PWO
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 PTTo
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 ONO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes fi�No
32. Do the flush tanks lack a submerged fill pipe or a peimanent/temporary cover? ❑ Yes JANo
S/00

Division of Soil and` -Water -_Conservation `OperationReview
0 Division of Soil aiid Water`Conservation :Compliance L spechoii > `
Division. of Water Ou"ty aCompltance Lispection
:]-Oilier Agency_ Operation Review
JQ;Routine 0 Complaint_ 0 Follow-up of DWQ inspection Follow-up of DSWC review 0 Other J
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted © Certified [] Conditionally Certified [] Registered 0 Not O erational Date Last Operated:
FarmName: ...... ...................................................................................... County:.....~.... .._......................... ......... ...... ................
Owner Name: ............... .................. Phone No:..............
Facility Contact:............................................................................. Title:..................... . Phone No:.........
FlailingAddress: ................................................................................................................................................................................
r`
Onsite Representative:.... tr-jL--Q ,! .... W�... r��.�. Integrator: ...... �........................................
Certified Operator:................................................................................................................ Operator Certification Number:.................. ........................
I.pcatiVn o arm:
.. �rn........................_..._..................................................................................arSx,.........!...............a.............
' .....................................................................................................................................................................................................................................
Latitude �� �� �•' Longitude
n Current - :,.:. Deli Curren g 'Design - t Design . Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑Boars
jNumber of Lagoons
°;Holding Ponds / Solid Traps
Discharges & Stream Impacts
1. Is any discharge observed from any part of the.operation? ❑ Yes RNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, 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 j�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 4 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: nrt-�-�
Freeboard (inches):..........J...lT) ................ ....................................................... ......I...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [NNo
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?
(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 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
❑ Yes ZNo
❑ Yes KNo
❑ Yes X No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes XNo
f ✓
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 IffNo
c) This facility is pended for a wettable acre determination? Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ff No
16. Is there a lack of adequate waste application equipment? []Yes W No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes YNo
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 jo No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) []Yes Dff No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IV No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes A] No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes j No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes A No
K- N,6-vi61afiogs :oi deficiencies -weria noted- during tbis;visit: - Y;oit :will -receive Rio: futther ..
corres oridenk abaut: this visit: :.:. ; .:. ; .:.:.:.:. ; ..:.:. ; . ; . .
Comments,(refer.to.question M Explain any YFS_ answers atfd/or any -recommendations orrany othier comments:=
Used of faciLty to better explain situations (use additional pages as necessary)
_. .
N fie,
Reviewer/Inspector Name { r = �. _ r w
_ L^ = x
Reviewer/Inspector Signature: x J � � Date:
3123/99

Facility Number:' — L?ate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ 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 8�No
28. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes �'N0
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 RNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes (jrNo
bona ,omments an or rawrngs
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Routine C Com faint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
13 Registered Certified ©Applied for Permit Permitted 113 Not O erational Date Last Operated:
Farm Name: 5° .. ...*2 .................... Countv:.......D!.L�.�k.'.�........................................ ........................
Owner Name: .................. IS-6....... 1..J .. . Phone No: ..C.�.��...Ics ..�.�.Z:. .........
---..... ----
Facility Contact: .......................... ........ ....... Title:
Mailing Address: ....... ..`1......... £a.VxGu.......
}........................................
Onsite Representative: ............. IS_[t..11.:.r...............................................
CertifiedOperator..........................................................---...................................................
Location of Farm:
................................... Phone No:
......... ?l ....4.1�`..t...l`?f...............................
..�5�ca
Integrator: ............
ntegrator:............M .---...----...------..........------ ......
Operator Certification (Number--------------
Latitude Longitude �• �' �"
Design Cur ent Design , Current Design
we' Capacity Population Poultry Capacity Population `Cattle Capacity 1
❑ Wean to Feeder
Feeder to Finish
-7L.
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
/Holding Ponds Subsurface Drains Present J10 Lagoon Area Spray Field Area
fl ❑ No Liquid Waste Management System
neral
1. 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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes �qNo
❑ Yes ;9 No
❑ Yes [P No
❑ Yes 01 No
tj
f�
❑ Yes MNo
❑ Yes 0 No
❑ Yes [).No
" Yes ❑ No
❑ Yes (� No
❑ Yes No
Continued/ on back

Facility lumber: 3) —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier:
Freeboard (#t): .............47j...
I0. Is seepage observed from any of the structures?
Structure 4 Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
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 waters of the State, notify
1D. WQ)
15. Crop type ......... .............'. .0....._ t!i`r in................... .................................
lb. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit"
❑ Yes 61 No
❑ Yes W No
Structure 6
0 Yes M No
❑ Yes P No
Yes ❑ No
❑ Yes n No
❑ Yes Q No
..................................................
Y,Yes
[I No
❑ Yes
Q No
9Yes
❑ No
❑ Yes
.17 No
N es
❑ No
❑ Yes
,PTNo
KYes
❑ No
0 No.violations or deficiencies were noted during this'visit.- .Youmill receive no further
correspondence about this.visit:
❑ Yes P No
Yes 1� No
Yes % No
Com%nents (refer to question ##) Explar.~n any YES answers-andlor any recommendations or any other con�mtenls ��
use'drawings of facility to better explain situations (use additional pages as necessary)
} `.
S• (re Y'�J ivy �iL1r�11.0 4. `e=�rlvc) �]L I'C.�L
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6 wL���
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saw
GCrvom�E(r•P s60)d lot (tatty
7/25/97
Reviewer/inspector Name _ .a
Reviewer/Inspector Signature: Date:

❑DSWC Animal'Feedlot OperatW Review
V-
c $ DWQ�Anlmal Feedlot Operation Site Inspection 4`
IQ Routine O Complaint O Follow-uR of DWQ inspection O Follow-up of .DSWC review O Other
Date of Inspection q
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
0 Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:.... _.... (..�._....._......_..... ...... _ ..... __.... ............ ... _ ..._ ...._..........
Farm Name:..%..
Land Owner Name:....�G. ar os..s�a�............... _.... _..._.. Phone No: �..�...
Facility Conctact..... ...... . .............. ......._.... ....._ . Title: Phone No:
Mailing Address:I._LiZ. ... Z.r--a _u..j_o...i...".�...... .4..:.... .._....... .. .a. ►t Yt .. �.� l . � f. ._.... -$. .��
Onsite Representative:...�� £ n[. ........ ......_....._........................_ Integrator:......._ u.r...�._.I�.. .._..............
Certified Operator: � i'1%i� .... C.._........4 ............. _......_........ Operator Certification Number: .. `��,? ..... _...... .
Location of Farm:
._..--- _. ---- . �y
Latitude ©• oG ` Longitude ©• ®4 ®64
Type of Operation and Design Capacity
Swine Des n Current Dese n Current Dien t ur ent`�:
,Cattle . g
. r . rCa aet Po ulatian ;. .Ca aci T Po ©lotion :�, 'lt ace .�Fo ulatlon
❑ Wean to Feeder ❑ La er ❑ Dairy
Feeder to Finish 3 6 7 Z ❑Non La er ' ❑ Non -Dairy
Farrow to Wean _ Wyk
�':
Farrow to Feeder Total Design
Capacity
Farrow to Finish � A e�
G
zn
❑y �Totai SSL CG Zo ;
Other
Number of Lagoons / Elol�ng Pondsy Subsurface Drains Present
e•
1 j
,1K A�,> �n � � „„ ��, � � Lagoon Area Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes H No
2. Is any discharge observed from any part of the operation? ❑ Yes 10 No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? �} a
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 9) No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes JKNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes allo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ,(No
4/30/97 maintenance/improvement? Continued on back

Facility Number: 11.,_,—.J1._.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
10 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (Lagoons and/or Holding Pondsl '
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
2. 25
10. Is seepage observed from any of the structures?
❑ Yes
®No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
® Yes
❑ No
12. Do any of the strictures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
JRNo
Waste -Application
14. Is there physical evidence of over application?
❑ Yes
JR No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type � �r r.rs� u.: ►.......------ -L i_30-Ar.. Q............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
J.Yes
❑ No
17. Does the facility have a lack of adequate acreage for land application?
® Yes
❑ No
l & Does the receiving crop need improvement?
❑ Yes
® No
19. Is there a lack of available waste application equipment?
❑ Yes
91 No
20. Does facility require a follow-up visit by same agency?
®,Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
jR No
24. Does record keeping need improvement?
0 Yes
❑ No
Comments (refer to questto'n'# Explain;any YES answers an' d/or;any recommen tions`or any other com"meats 4
Use drawings, of facilityto better exp n situations': {use additip pages as necessary) s.
a-„,L e-e .0,
a r -e C,- ,.-ems v •-• w >� l 1 S lL o v L c� w S o e r e.v_
i G . j 17 � b t - CCO i S b ro „u .,� .•• S {_ , Cd . TA, S
Vt� V U 10e, b V "� p Q�y� • 1 I r c r t-WvL 1<' CO S V r-2 f
e o p e r 4 f o ,r vv¢ _S S VI �� t [ i t", j -^.`-0l �-a $ p i�
;--k- f- tk a. f-D o V- c e S �>� e V S e_a 61
24- &c{ c- v,- {- Sa1 5OL -NtIe-S.
Reviewer/Inspector Name > € ' « •.
Reviewer/Inspector Signature: AA - Date:
cc: Division or Water Quality Water Quality Section, Facility Assessment Vnit 4/30/97

Site Requires Immediate Attention -
Facility No. _ ;k N a 1 V
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: — 2- , 1995
Timer ' /
Farm Name/Owner: { G r
Mailing Address:
County:
Integrator: D 6! �/ Phone:
On Site Representative: 1feN �J��i��ynn _ Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity- Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° Di Longitude:' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: Ft.' ` Inches
Was any seepage observed from the lagoon(s)? Yes or(5 Was any erosion observed? essr No
Is adequate land available for spray? es r No Is the cover crop adequate? Yes r No
Crop(s) being utilized: Co 4TAi{—e-- --.- - ---
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(�) or No
100 Feet from Wells? Ye or No.
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or@�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or 00
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oig If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y*�SNor No
Additional Comments:�S111 !�
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed-
. - -