310179_INSPECTIONS_20171231

NORTH AROLIN _
Department of Environmental Qual
2'
d

Type of Visit: QtCo pHance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
a As
OnsiteRepresentative: (L 4-z
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 2.�k' O Z_ Z
Certification Number:
Longitude:
Swine
an to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P.
Dai Cow
can to Feeder
.f ZS
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) . P,oul_ .
ILayers
Design
Ca aci
11
Current
P,o P.
DairyHeifer
Dry Cow
Non -Dairy
Beef Stocker,
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I
lBeefBroodCow
Other
OtherI
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZS
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E17No
❑ 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
2fNo
❑ 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 at, notify DWR
7. Do any of the structures need maintenance or improvement? N me❑ 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 E!�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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? 0s No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 2
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes 2
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: I jDate of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesD No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 Cl 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 ; ' - ❑ NA ❑ NE
❑ Yes 1:;K'❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes ZrNol ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No
❑ NA
❑ NE
2No
rf
❑ NA
❑ NE
No
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawingsoffacility to better explain situations (use additional pages as necessary).
n `z t l CiS
G o c //p c/n•. i j- I � c c oi.�
pose, S /e ��• d s�y4
Ix4-- 3 o QO n'o p
GMJ-vL,.r- T.^wMM/( /,Lj�,..o�,ff— VO
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of 3
Phone: /l% 7y k 7.1rpy
Date: k
21412015

for Visit: (YRoutine 0
Date of Visit:
Farm Name: T�
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
0 Referral 0 Emergency 0 Other 0 Denied Access
Arrival Time: U� Departure Time: County: D J N Region:
Owner Email:
Title:
Phone:
Onsite Representative: (3 �y3+ I v t= ciFu_., Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
I INon-Layer
I
f
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1) , P,oultr.
Layers
Design
Ca aci
Current
Pao ,
D Cow
airy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeefBroodCow
Other
Other
-TurkeyPoults
Turkeys
Other
Discharges and Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 DW R)
2. Is there evidence of a past discharge from anyrpart 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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes El ❑ NA ❑ NE
❑ Yes YNo
o El NA ❑ NE
El Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

. Facility Number: 1 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes ❑ No ❑ NA ❑ NE
��
Stt(r��u/cctuur�re,I'I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA6rc JPJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(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 environmZo
threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[o
❑ Yes /7.�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L No
❑ NA
❑ NE
acres determination?
/
17. Does the facility lack adequate acreage for land application?
❑ Yes E I ' V o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes CNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other: 11
❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspectionns, /❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Ye s ,I'IyO ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Ye s No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below
❑ Yes I �J ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

. Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste applicaiion equipment as required by the permit? ❑ Yes &No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes V No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑NA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No.
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Io
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 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
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
[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
Io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�/N(
NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Yes
�
y
❑ NA
NA
❑ NE
NE
❑
❑
❑
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility;to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Type of Visit: 1Z) Co/npliance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: RRouou.tine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit Arrival Time: Departure Time: County: bP(-T7j' Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: (B"/ tr CA=C-1a _Ukl Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: V7,0
Certification Number:
Longitude:
::1
Swine
Wean to Finish
Design Curren[
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacih Pop.
Dai Cow
Wean to Feeder
s pp
Non -La er
Dairy Calf
Feeder to Finish
' 6 o u
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P�oult ,
Layers
Design
Ca acih�
Current
$o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boazs
Pullets
Beef Brood Cow
Q[her
Other
Turke s
Turkev Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [�] No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: I jDate of Inspection: 1$
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2
Identifier: LA(T6OP
Spillway?:
Designed Freeboard (in):
❑NA ❑NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): 9-1_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EfNo
❑ 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
dNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment
1 threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
El Yes
;TNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2rNo
❑ 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 [;kNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [� o ❑ 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
EJ'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
AIo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
dyes
GJPNo
❑ 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 2/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gto ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 51 - Q tj I I Date of Inspection: (, / I YL 15
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ef'No
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
LA 1 o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
do
❑ NA
❑ NE
and report mortality rates that were higher than normal?
No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E�
❑ 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
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 E1,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
❑ Yes
RE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone
Date: s
21412015

Type of Visit: p Co Hance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: U Departure Time: j County: / Region:
T-TT
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: (�� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
L_l A ZZ
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
JI-ayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
P
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dt, P,oult , +
Layers
Design
Ca aci
Current
$o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
Beef Brood Cow
Other
El Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 I YNo
❑ Yes [—]No
[-]Yes [-]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ o . ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
Pagel of 21412011 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. I�storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier: (_
Spillway?:
Designed Freeboard (in): 2
Observed Freeboard (in): 23
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste managemqnt or closure plan?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme al threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ 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
❑ NA
❑ NE
maintenance or improvement?
YNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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?
Jam-' es
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0o
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E✓ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
20. Does the facility fai o have all components of the CAWMP readily available? If yes, check
❑ Y s
/Yes
No
❑ No
❑ NA
❑ NA
❑ NE
❑ NE
the appropriate b
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes d No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes VNo
- ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes d b ❑ NA ❑ NE
25.1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [7NNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E N ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes E.—Ko
❑ 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 I—Lt�o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
/'
❑ Yes ;No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
—/
❑ Yes 12(No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
111TTT
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ®N
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
IS.) 5 (y-d 5 ft�U &-V-6Wa JC, p-N C) SW 0-SO Ct3Cru^uDp , 7t-W (
PAV6 REM°dC®, W-r+J'V6W CLbs(5 APoz— IS.
0 Aw
Reviewer/Inspector Name:
OWNvft- Said GJVV,
Reviewer/Inspector Signature:
Phone: ('
Date: i
I�
Page 3 of 3 ' 214/1,011

(Type of Visit: U Corgpliance Inspection U Operation Review U Structure Evaluation (� Technical Assistance I
Reason for Visit: _ C/�JJR'ouutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Deemed Access
Date of Visit: I_T Arrival Time: Departure Time:,' County: Dup �./I �J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �1 Title:
Onsite Representative: lg2EA)T N -=r6 ('L/U
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
2�Z02�2/
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
]Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I)t. P,o_ulh. Ca aci P,o ,
Layers
D Cow
Non-Dai
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Y❑ NA ❑ NE
❑ Yes 2Ves
YN ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

lFacility Number: Date of Inspection:
Waste Collection & Treatment
4. 14�storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1, Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: n d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2,1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[yNo
❑ 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
R✓ 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,
No
notify DWQ
7. Do any of the structures need maintenance or improvement?
[—]Yes
❑
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
D40
❑ 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 Zo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [-]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Io ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate b
❑ Yes gN�
❑ Yes
❑ Yes No.
❑ Yes ICJ N
❑ Yes (�No
❑ es //No
&Yes ❑ No
EWUP El Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q-<o
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ Yes
� N9
❑ NA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Ins ection:
24. 6id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
V�N [:]NA ONE
No ❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 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
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
/
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ff io ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
/
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes I__I " NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
L❑
❑Yes N/o�l' NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes W+ "V u 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).
2,01) 1-14✓E 0 K/Akc- Ak)p TECH S-KC SSG l,W Ve
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
Date: 5 S
2 4/20 I

Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time:© County: 1 > Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 13V-&o T M ;-r" - ,t— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: 2JL02Z/
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
3 75
Wet Poultry
La er
Non -La er
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to sh
Dairy Heifer
Farrow to an
Farrow to Feeder
Farrow to Finish
Dr. , P,oulh.
Layers
Design
Ca eci
Current
I,,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes IQ i o ❑ NA ❑ NE
❑ Yes FO/No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: - Date of Ins ection:
I Z/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L14 6-OOJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JdNo, ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C21/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes MNo ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes 2r]�N ❑ NA ❑ NE
❑ Yes [/No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes Q tQo
❑ Yes Ld��0
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes C5 No ❑ NA ❑ NE
[—]Yes Io ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes Nc ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 61?4101 ❑ NA ❑ NE
Page 2 of 21412011 Continued

Facility Number: Date of —Inspection. 11 ,
24. D`td the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
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
❑ Yes
0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
❑ Yes ff&o ❑ NA ❑ NE
[—]Yes ❑'1�o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft. Explain any YES answers and/or any additional recommendations or any other comments.. x I
Use drawings of facility to better, explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone(-/f 6 "
Date:
2/4/ 011

'Type of Visit: 10Cnpliance Inspection U Operation Review (_)Structure Evaluation (-)Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: S' $ Arrival Time: ] Lo0 Departure Time: iS County: QLVLtiV Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 6(LkNt" 'r m-toa ay Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design C•unreot
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D ,�P,oult .
Layers
Design
C•_a aci�P,o
Curreor
,
Dry Cow
Non -Dairy
Beef Stocker
NJ Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[:]NA
❑ NE
❑ Yes Ko
N❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

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

Facility Number: Date of Inspection: S 11
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes 01N� ❑ NA ❑ NE
't
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
N
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
90
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2 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?
El Yes
Q N
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
'Co
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C Noo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
� yNo/❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility tobetterexplain situations (use additional pages as necessary). m
20,) Fay 1&(C-A1j_W 5OL-0 fin 9-aAgr", dCep 00A1Ei,) 6JUP1 OcuGn/A�
dXC„
Reviewer/InspectorName: ( �/-7�j ['� �Jti
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /1176-2.30
Date: J A
21412011

Type of Visit )t compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit '�Routlne 0 Complaint O Follow up O Referral O Emergency 0 Other El Denied Access
Date of Visit: '' J /d Arrival Time: OS Departure Time: County:
Farm Name:yVEI V4r_ Owner Email:
Owner Name: "LsEn/611 S G-19AYAA Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: 1�-EM/l/S GR-At1AAA� Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = ' = Longitude: = o = ,
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 �kNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes �B`No
❑ NA
❑ NE
❑ Yes )§.DCo
❑ NA
❑ NE
12128104 Continued

Facility Number.3i —
Date of Inspection MIS710
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: (_/}GooN
Spillway?: n
Designed Freeboard (in): (. s
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes � No ❑ NA ❑ NE
El Yes ,6 I No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,,,IXI 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 ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? I
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ElNA ❑ NE
❑ Excessive Pending ❑ 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) se, 9P_q- P�
13.
Soil type(s) (-7t—opSQCQ_C�
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
YL�ttt
El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
Elt,� Yes
ls
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations orany ocher comments l.
Use drawings of facility. to better explainsituations (use additional pages as necessary) '� 's g
Reviewer/Inspector Name
Phone:
//40 -,
Reviewer/Inspector Signature:
Date:
3115-Jld
12128104 Continued

N -
Facility Number: — Date of Inspection f0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ 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 0 Desig
n ❑ Maps ❑ Other ���,,,(((
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes , No [:INA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ )Wste Transfers ❑ Anal Certification
❑ Rainfall ❑ Stocking E:] Crop Yield El 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes D(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 o
r❑
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA XNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
KNA
❑ 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 )dNo
❑ 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 O 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 KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
���,yyy,,,
❑ Yes �I No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes jo-No
❑ NA
❑ NE
UQ. H .
/a1000/09 i. I
�G I wll-LCC gIMS -Ovt:GZIF- �ICf1�)oE - WILCcACC IFTHCRE:
I S A (�R cQ LC -AA . J
PLC=A--rJE GET C-CQt�oF �o�a �ac�Da pt a« t�IT�r �E�t os
C'A( l6GtA;)o y! D,tE �bJ�
,212VO4

(Type of Visit acompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit '% Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: '�-I--� Arrival Time: �("'^�� Departure Time: County: �-: Region:
Farm Name: �T V A�� 1—AQ.n Owner Email:
Owner Name: �F_NlV 1 S L L"A Phone: �CII b_9_4/5l—QC?33
Mailing Address: 13U ©U-I/VA �SQ 1�ENR7NSVI11FT/y O[ J�I 1
Physical Address:
Facility Contact: Title:
/
Onsite Representative: ENN 1 S l`1" H A M
Certified Operator: _
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =U =' = Longitude: =o=, [�«
Swine
Design Current
Capacity Population
Design Current
Wet Poultry Capacity Population
Cattle
Design Current
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
5 d yd
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Dairy Heifer
❑ D Cow
❑ Non-Dai
El Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑Beef Feeder
❑ Pullets
❑ Turke s
❑ Beef Brood Cow
Number of Structures:
❑Turke Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 VkNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
n No
❑ NA
❑ NE
❑ Yes
ftA IpI No
ElNA
❑ NE
Page I of 3 12128104 Continued

Facility NumDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: %Aa)oN
Spillway?:
p
Designed Freeboard (in): /
Observed Freeboard (in): y�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rrr,��ry
p(J No
[]NA
[I NE
(ie/ large trees, severe erosion, seepage, etc.)
, v
6. Are there structures on -site which are not properly addressed and/or managed
[]Yes
Wo
❑ 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 DdNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift
[IApplication Outside of Area
12.
/❑
Crop type(s) EEn-M L
13.
Soil type(s) C-�Q(��S F::oQp
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
A No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
O 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
LA)RCI ( t dq O 1 C_ C49-1) 14"I UG S Fv. T i�P y t/V FI L-E
�A(Z6^ L�,CS Ci(ZEl4 I .
Reviewer/Inspector Name I Hmawup 'Czi4 //JE S I Phone: `7/0 - -r7 (D" 1561"t
Reviewer/Inspector Signature: Date: 6Z 16L 16 9
Page 2 of 3 12128104 Continued

i
Facility No Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ 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 ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. """"""""""""''''''��,� ❑ Yes OnNo[I NA [I NE
El Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis Elste Transfers ❑ .ifinual Certification
0 Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes V No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
KNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
kNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
X 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
A 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
M No
❑ NA
❑ NE
Page 3 of 3 12/28/04

Facility Number �R
{� Division of Water Quality
0 Division of Soil and Water Conservation �.
0 Other Agency
IType of Visit ?& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit P Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9 d' Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: 1'�'ENHI s 6;RA"AA_ Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ='
= Longitude: = o ='
=
11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
S'550 135 r. d I JLJ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current- •�`
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures: El
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 M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
" No
❑ NA
❑ NE
❑ Yes
JN No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 f — Date of Inspection a
Waste Collection & Treatment �.y
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1I 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: I_A6� �'s
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9 43
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes A No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) Arr
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 ,,M 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 5kNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PkNo ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 Drill ❑ 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
AV 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
y55
ISI No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
FAT Co?!SoF
VJILL fp -Mo Sfw C-zT 4 G€T cutAP SwITcNr �
C4AAh�e-oF-awIVIERSH'141(_otA
`
5` COPaPLGTC St_uCCI= StA"E, IN 3c�oa�js V-IVLA)L 76 d-R_r1'_.j(3F
,--LL 1 S &IV 1J l yw
Reviewer/Inspector Name AWANQ# 6Qj r=S Phone:
Reviewer/Inspector Signature: Date: o A
12128104 Continued

Facility Number: 3 [ —[�I Date of Inspection 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps [:]Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes DQNo ❑ 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
[[X No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
DINo
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[p No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
® Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
qNo
❑ 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
PR 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
M No
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
4
❑
❑
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
[ZNo
❑ NA
❑ NE
Comments and/or
12128104

Division of Water Quality
Facility Number _ O Division of Soil and Water Conservation
F
Other Agency
Type of Visit OiCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit g(Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: C % Arrival Time: IIca Departure Time: ounty:
Farm Name: %� // /�D-n/�\ �Owner Email:
Owner Name: . e J.`�i�✓n�0� -r-f Gf✓/yZlt�'r� Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: i✓G�rrt%G 'j
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm:
Latitude: = o Longitude:
= o = ,
Design Current
M1 Design Current - -
"Design 'Current
Swine Capacity Population
Wet Poultry
Capacity Population ` Cattle
Capacity, Population'
❑ Wean to Finish
][]Layer
E]Dairy Cow
t
Wean to Feeder 13fEV4,52Z90
ILJNon-Layer
I I ❑ Dairy Calf
In Feeder to Finish
❑ Dairy Heifer
I I
... ❑ Farrow to Wean I
Dry Poultry
❑ D Cow
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Number of Structures T]
❑ Yes XNo ❑ NA ❑ NE
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
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ANo ❑ NA ❑ NE
❑ Yes 9f No ❑ NA ❑ NE
12128104 Continued

b
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier: 966-1
T
Spillway?: Awe
Designed Freeboard (in):
Observed Freeboard (in): �_l�
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes I
❑Ye ❑No
Structure 5
❑ Yes gNo
❑ Yes Aj No
❑NA ❑NE
❑NA ONE
Structure 6
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes .C� 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 Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement? �,{
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes yJ No ❑ NA ❑ NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground [I 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 ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ YesNo
❑ 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?
ElYe�No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
El Yes �No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any'other comments . -�- *
Use drawings of facility to better explain situations. (use additional pages as necessary)'-'
�'� 9 0 � ✓oyG �S7 iPc�> ��atJ E.Q � 2 7.✓ [min � /�
Reviewer/Inspector Name Phone: 3Z�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/Z8104' Continued

Y
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,,____,,,,////No El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VJ No ElNA [INE
the appropriate box. ElWUP ElChecklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
El NE
❑ Waste Application [I Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑...///NA
[INE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes ElNo
1[J NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El 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
[:1 NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes (!❑ No
,YJ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes XNo
❑ 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�XNo
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yeso
141,
[INA
[INE
33.
Does facility require a follow-up visit by same agency?
ElYes
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

i
Facility Number 3! ;
` Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
IType of Visit 0Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Olt' Arriv//all //T�ime: , 00 Departure Time: �Q! County:
Farm Name: ! �i //AH /".¢/jM Owner Email:
Owner Name:/�/�n/NO�—�fi✓/I�Z�^ g Phone: _
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone No:
No:
// /L1/QY
1 ✓
Onsite Representative: JtfAi✓dDaJ c�-/`.i✓��s Integrator: Ou!/j
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 U 0 , [ Longitude: [—]or--]' 0
Discharges & Stream Impacts
L 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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
YrNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

. r
Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Spillway?:_
Designed Freeboard (in):
Observed Freeboard (in):_
Structure 2 Structure 3 Structure 4
❑ Yes /No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
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.) /,.,C,
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes yJ 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? ElYes IQ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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
maintenance/improvement?
❑ Yes PNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
El Excessive Pending ❑ Hydraulic Overload El Frozen Ground El 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 W/ii dd Drift ❑ App cation Outside of Area
12. Crop type(s) �L/ !/O �1ij /� �{h ( /(/�/G sE�302
13. Soil type(s) 4/7 A
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? OYes ❑TTT❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;3'No
❑ Yes ONO
Comments (refer to question f: Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑NA El NE
❑ NA ❑ NE
�J ).Soin� CG2f�,✓ `5741- f5 A/mT �o �,✓os I.� L'a rztr.�c� zoo✓ C!/E,—it
���t
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone: Z(fL
Date: 134

i
Facility Number: — Date of Inspection
Reauired
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
[I NA
El NE
the appropriate box. ElWUp El Checklists El Design El Maps El Other
/////�
21.
Does record keeping need improvement? If yes, check the appropriate box below.
/
ICI Yes
❑ No
❑ NA
❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sroill Analysis [I Waste Transfers
[I 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?
PYes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VrNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V 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
;dNA
❑ 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
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
7 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
/S >,CZvi OGL !7jr
Or✓cy O,r,� FfGoL,v Ovf�g<E��g �p,u� �js �Ou /7`RF /�� SldP
—�ieg�nD2g 200,E To �'cr,eaE.✓r ��P �y,g2 ���,
/1% �/4n� ©df-QAPc°�zchr�v�✓ /%c�,��9.eL �r, C
—-�n�2���L �o� �ov�✓ �Fi�7Z'ocJ.
Zile 2� J,�uI- A/4;,O IeO Oo
Page 3 of 3 /� A J � ©�O,��LY 12128104
n/d%,��L f�CQQG� /_
jf4in 1pja „tas / .6 Gr% mAz.✓rfiz�✓A

i
Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
�
lev
Date of Visit: Q5 Arrival Time: D.Q eparture Time: j ounty: "LZ Region: `-"^
Farm Name: 1,. Owner Email:
Owner Name: .1�0 /�/✓H v"J Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: v
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
C
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�j ❑ Non -La et
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 Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures: a]
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 Id No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes xNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

1
f
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 153
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VrNo
❑ 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 X No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
,�{
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes yJ No
El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
/No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop WipdoV ❑ Evidence of Wind Drift Q Application Outside of Area
12. Crop type(s)
13. Soil type(s) / y. a It,
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
wrYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ yes
[Z"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
)Co..�>� ✓�F Z' 441oei t/�.�✓ �, paot/ir✓� %ff (�u/►n uo.� 5T,9,✓p
- /�2�.x At/ NG`D�i �C FG �oi✓�4c %7�/lon/o�'I zs (� �T✓ ���/t- /7✓SLST �
IReviewer/InspectorName 1LA69 z4j;+.; 1 Phone: Y42W Tt0 I
Reviewer/Inspector Signature: / Date:
�' 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents ,,,.........,,,(((
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 1/J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ yes �& ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Oyes
❑ 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 10
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JZ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
VNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fib No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�No
f
[I NA 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
rrr
ty 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
[Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
- No
❑ NA
❑ NE
1Additiooal Comments and/or Drawings:
21)/✓/f� Y -` Y//Q / YiQM
�p2 00 /Yl�r. 1471/p
-OA (oD DABS-'a.� �a ��•� r���
�'o�• ✓ �4e- sn,
A
12128104

(Type of Visit P Compliance Inspection O Operation Review O lagoon Evaluation I
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Dale of Visit: �-Ff--`f---,'--'Time:
Facility Number 1
Not Operational Q Below Threshold
❑ Permitted E3 Certified E3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:..._.
Farm Name: w6_T Qll!!� FA. .................... County: _il.U.PZ iJ.
Owner Name:
Phone No:
MailingAddress: ..__............................................... _..._._.._......_.........._...._._._._..............._._._._.__._._._........__..__.._..._.._..._..__._....__._.__._._....,
Facility Contact: ......._..._.......... Tide: .................... .......... ................ ... ........... Phone No:
Onsite Representative:-.--_50"14NWJ E!- 1, 1_A$.._ .. Integrator: _. C (Z----- �..__.
Certified Operator:
Location of Farm:
Operator Certification Number:,_.,,,,,_,,,,,_......,,,,,__._._.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =' =11
eanto Feeder
S'S2
/ 00
==
❑Layer
Feeder to Finish
i <
❑ Non -Layer
Farrow to Wean
== _
Farrow to Feeder
`.3
❑Other
Farrow to Finish
= Total NMI
2 `
- 7
❑
Gilts
Boars
Disebar•Qes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes /No
❑ 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 gaUmin?
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 dNNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 040
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes CrNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......... ... !.... _............ .......................... ... ..__-_._...._...__....... __.___.
Freeboard (inches): 31
12112103 Continued

Facility Number: ^ —jqq Date of Inspection
5.`Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes t[I
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ElYes No
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes p/No
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes
IN co
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ LA Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type f3E.1 W /DA (6) 5-06 LL Gs4A::1nJ 00GOU6E 0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes N%
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ENO
15. Does the receiving crop need improvement? ❑ Yes © No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
[�No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
/NNo
U40
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
No
Air Quality representative immediately.
0014 rL SpaAycD g6geLZC.TPC
I?Gc 'DS L
Reviewer/Inspector Name_
Field Copy ❑ Final Notes
wo L=ME ADDEP .514 FXS-t MoNI {
Reviewer/Inspector Signature:
Date:

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

Date of Visit O Time: /O
Facility Number ,3
0 Not Operational 0 Below Threshold
© Permitted Q'Certtified 13 Conditionally Certified 0 Registered
Farm Name: /—`-�fi�.-'._�lYl
Owner Name:._. ..... .7.�t14/.✓!1i</il..`...s..� L�%(.��'r_...................... _..........
Mailing Address:
Date Last Opera/ttg��d or Above Threshold:
County: _ ..................................................!/PG<'
Phone No:.
FacilirvContact: ....................... :........... _......................................... Title:................................................................ Phone No:......................................
Onsite Representative:.... i`�/. /._✓.._...._ Nt f /� 5...... ......... ..... Integrator...Cif. " .L.:.Jr........................._...._.__......._...
Certified Operator,_,,,,,,,,,,,_,�__........_........-- _, ............. Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle []Horse Latitude Q` =` L—I" Longitude =• =' ="
Wean to Feeder
Feeder to Finish
Farrow to Wean
Other
Farrow
Discharges & Stream Impacts
Subsurface Drains Present 1101,agwnArea 1EISpruyFieldArea
No Liquid Waste Management System
1. Is any discharge observed from any part of the operation? []Yes /No
Discharge originated at: 0 Lagoon [I Spray Field 0 Other
a. If discharge is observed, was the conveyance man-made? 0 Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify D WQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify D WQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? 0 Yes. XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway 0 Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:... __ ._.—.....�_...__..._.. —.....__._......_......_._........-- - ....__....... _....... - ._.......-- ......_._.......__.—_......
Freeboard(inches): ........ -.?................... ............ ....................... ... ................................. ................................... ............................. ........................
t......... ..:...

Facility Number:3�— ?9
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the actuation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over apulication? ❑ Excessive ]
12. Crop type
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Hydraulic Overload
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other 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? (id 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?
❑ Yes W(No
Q Yes No
❑ Yes �No
❑ Yes TXNo
No
❑ Yes //N No
❑ Yes iNo.
❑ Yes XNo
❑ Yes ;0 No
❑ Yes /Id No
❑ Yes []No
[I Yes [I No
DI Yes ❑ No
!!J❑1 Yes XNo
[]Yes /No
❑ Yes RNo
❑ Yes All
❑ Yes ZNo
❑ Yes /No
❑ Yes �o
El Yes "XNo
❑ Yes
/�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? . ❑ Yes ICI No
No violations or deficiencies were noted during this visit, You will receive no further correspondence about this visit.
Field
/1100V %S
Final Notes
Reviewer/Inspector Name
22
Reviewer/Inspector Signature:
Date:

Facility Nu�� Date of Inspection I
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?
11
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
,�N0
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
ElYes
}1J No
29.
roads, building structure, and/or public property)
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 fm(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
o
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
[:]No
Additional Comments and/or Drawings:
—/Vo SmgZI- IrRAJ�Js ��AN�Epj�/.F25 i�E.4�P, //
Wf FQS.
'®ulN�2 (�.�FFPd`PiE,p 17141
Gf/i9��F Y�L14n1. S ��/fal�cf}� 6y�2i%S7 F�
�dF�f�� � �RFf1-o�}�v�N•D LgG���An/ �n'� /�� h�us�s �j
'Ore.
Q�Fi2 � �l14K��� ��7,P�0✓FMFNTS �z�� ���s,�,�>�.yF�
O5103101

Divavoa of Water Qnalily
Q Dinston of Sod and Water Conservation
(Type of Visit 0 Compliance Inspection O operation Review O Lagoon Evaluation
Reason for Visit GfRoutine O Complaint O Follow up O Emergency Not'dication O Other ❑ Denied Access
Facility Number
Date of Visit: a-dl Time: Go
Q Not Operational Q Below Threshold
C,Permitted [3 Certified E3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
1441
FarmName: ............... ....a...................................................................................... County:.... Il........................................................
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: .....................................................................................................................
Onsite Representative: ^' r........................................................................._ Integrator..1...cj�°A� ..
Certified Operator:
Location of Farm:
Operator Certification Number:,,,,,.,,.,.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =< =11 Longitude =• =1 =«
Swine
Current
Pnnntatinn
Wean to Feeder
a
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
:urrent- Design
,notation- Cattle rna rit;
Total Design Capacity
Total'SSLW
- Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JOSprayField Area-
,
Holding Ponds/Solid=Traps ❑ No Liquid Waste Management System
Discharges 6r Stream Impacks
1. Is any discharge observed from any part of the operation? ❑ Yes kNo
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 ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �f No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): 3'
5100 Condmied on back

Facility Number: 3 — Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[]Yes
ptl No
seepage, etc.)
'T
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
4
closure plan?
[]Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
NrNo
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?
IKYes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11. Is there evide a ofnF over applicati� ❑ Excessive Pon ❑ PAN ❑ Hydraulic Overload
❑ Yes
WNo
12. Crop type t{p12Y1- w c{f o " Ste.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
kNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
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?
jq Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
,CNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
#�rNo
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
9No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
�(No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O�No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
C�No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
t No
•
• Rio-vi....f. .......... •were noted ...ih this...1:-Yo(t will-ieceiye do further ...... -
.
, coriesnorideirce: about: this :visit: - : - : .................... .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. = Use drawings of facilityto better explain situations. (use additional pages as necessary):
t 1 n
`l� l ei- wzL c o L=z Al ^t \ �� cp c�t' r���e ocSr l es� ec-1 L -
�i;Mek Lit
0 �kf-V,e4 i It mot-eVJ�'4, Keer LyLJ({_�
Reviewer/Inspector Name U eokl-\�
Reviewer/Inspector Signature: Date: —Q 5/00

Facility Number: -3 — Date of Inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0 No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
�j No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes]
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
5100

Division of Soil and Water Conservation ❑ Other Agency
ivision of Water Quality
Facility Number
of DSWC review
Date of Inspection
Time of Inspection I fU %W 124 hr. (hh:mm)
13 Registered ertified 0 Applied for Permit E3 Permitted 0 Not Operational Date Last Operated: _.... .......
....b1` 4"I —{1 "'l f R ,/L�f�ts!!.. ................. Farm Name: ............................./.!'.�..........._.......---....... County:........... (Ul
OwnerName: ................................................... ........................................................................ Phone No:..................................................................:....................
Facility Contact: ....�.t°f. al'I ..... Title: ,,...........Q. 1./...................... Phone No:.,.................
MailingAddress: ......................�...j.7�.....,...................................................................................................................................................................... ..........................
Onsite Representative: .....c °''"P 1/cN�.........� t.I t�.S.... Integrator: .................................................................................
Certified Operator:............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
Latitude =• =, 0" Longitude =• =` ="
'". _'..� Design` ,Current^ :Design:: _Current ,,.;Design . ;Current,
Swine- Capacity Population Poultry Capacity Population m, Cattle Capacity Poptation v=
�..:>>. _
to Feeder _ ❑Layer ❑ Dairy ;`.'
,. ❑ Feeder to Finish JU Non Layer 1 10 Non -Dairy .,
❑ Farrow to Wean
❑ Farrow to Feeder o ❑ Other a_
❑ Farrow to Finish Total Design Capacity,
❑ Gilts ,
❑Boars Total Skw
Y
Number of Lagoons / Holding Ponds �. " ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area tix
=� ❑ No Liquid Waste Management System
General
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 dischar,c is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in -al/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 `ram
❑ Yes `k9 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 12�Nq
❑ Yes �No
❑ Yes KN,�o
❑ Yes tAo
❑ Yes )Ko
Continued on back

Facility Number: — Date of Inspection
6. Are *here 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?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11_ Is there evidence of over applicatioe. ❑ Excessive Ponding ❑ PAN
12. Crop type
10
❑ Yes I�{'N0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(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?
�Vd •yiolafiofis.. ilef►c. ....were itgted during this:visit: - YOl} :will-reoeipe fit* fucthgf -: - :
correspondence: abotit: this :visit_
❑ Yes KNo
❑ Yes Al' No
❑ Yes XNo
❑ Yes *o
❑ Yes KNo
❑ Yes S2rNo
❑ Yes ❑ No
❑ Yes
❑ No
❑f �Yes
t
❑ No��
100 es
-ON[i
[]Yes
VNo
❑ Yes �(No
❑ Yes LNNo
❑ Yes OINo
❑ Yes fiZ-No
❑ Yes X'No
[]Yes )d_No
[]Yes _�dNo
❑ Yes 0�(No
❑ Yes X40
LComments (refer to question #):-Explain auy. YES answers ane. d/oany recommendations or any other comments *-
Use drawings of facility to better explain situations. (useadditional'pages as necessary):
4� ,�- wrjl W-/A�
Reviewer/Inspector Name F1: ,
Reviewer/Inspector Signal
Date:
3/23/99

Facility NumDate of Inspection
9dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes f0i 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 �(LNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, []Yes '4No
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 f 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 INo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes /4N-0
3/23/99

[3 Division of Soil yand Water_Consei•vation Operation -Review
13Division of Sod and Water Conservation - Com fiance ecUon
P InsP
' 'Division of Water Qttality -Compliance Inspection zc _
1Other-Agency,--16 til6n Review -.
O Routine O Complaint O Follow-up of DWO inspection O Follow-im of DSWC review O Other
Facility Number 3 Date of Inspection I '$ 20 F
Time of Inspection I j-5---.24hr.(hh:mm)
0 Permitted,pKertified 13Conditionally Certified [3Registered Not O erational Date Last Operated:
Farm Name: �!.. i �. ?e '(C....... rz--A.�'.M............................................ Cnunty:........ A._Gf P....( eJ
Owner Name:
Facility Contact:
Mailing Address:
Title:
Phone No:
Phone No:
Onsite Representative: .... SL.......................%✓'....................... In[egiator:.....CA ..................................Z.:<....`.5..........................................
Certified Operator: ................................................... ............................................................. Operator Certification Number;.....!.T33
Location of Farm:
Latitude =•=' =" Longitude =• =' ='<
Design Current
Design Current_ :_- Design Current
Swine - Ca achy Population '
_
Poultry ,- .Ca -Capacity Po ulation ,.Cattle Ca achy Po ulation:.
can to Feeder 359 7L
, ❑ Layer JE1 Dairy
ff Feeder to Finish -
[INon❑Non-Datry
-- ❑ Farrow to Wean
-
❑Farrow to Feeder
❑ Other - '-'
❑Farrow to Finish.-:
Total Design Capacity '
_:..' ❑ Gilts,
❑ Boars
.Total SSLW
.:Numbecof Lagoons-
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Are' ;
1`
.' _Holding•Ponds / Solid Traps E:=
= ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes GT<o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes J'No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes El No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes E�No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ErNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ErNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes .❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 7
Freeboard(inches): ........_J.....(c ................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ 1
Yes �J No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Date of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
L3`&o
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
/ErNo
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
FeNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[2rNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
0No
12.
Crop type QA4 S M _ GZA)- J
13.
Do the receiving crops differ with those designated i the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
L2'No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
�ZNo
b) Does the facility need a wettable acre determination?
❑ Yes
PN0
c) This facility is pended for a wettable acre determination?
❑ Yes
, Fje'NO
15.
Does the receiving crop need improvement?
❑ Yes
IP'No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
J;'No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
J21No
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
Q4110
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste atr�lysis & soil sample reports)
❑ Yes
O'No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
O"No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
LErNo
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
.0<0
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
RNo
.. �.. violafigt.. I deficiencies were J ... during this:visit.'-:You' ill-receiye iio further
.
correspondence: abbot: this visit: ::...: .:.. . ... . :: .:....... ......... .
Comments (refer to question #): Explain any YES: answers and/or any recommendation's or tiny other comments
Use drawings of facility: to better explair situations: (use additional,pages as: necessary):::;
tL T)'0'4 i F:eLOS' orJ A pE. PCRe BAr"S _Tt1c.,s W V0
eJeR-APf t_Zc w v as AeE 1W rFncr FL CLI>g < i ac . � c ru ic14-
tw\4i aGE:n tf ¢ "tAS- CAL'C `J Y-A ✓� Wee, Ae?OcA 6d ay THerv_ r*6ves
Reviewer/InspectorName
Reviewer/Inspector Signature �_�' /- A Date: R Iz- y�S
3/23/99

Facility Number: "3 — (7 Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
IIo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
9190
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
E—a'%lo
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
ZNo
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
(a No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
P No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
[]Yes
JZNo
3/23/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
Facility Number Date of Inspect ion I ( gM?
Time of Inspection � 24 hr. (hh:mm)
D Registered 10 Certified E3 Applied for Permit D Permitted 10 Not Operational I Date Last Operated:
Farm Name: ............. I&k........00 .. y:........ ll� N .......................
........................................................................ Count �. t............................................
Owner Name: ........ _...........S�1P.I.Vw.''&...... ......... S2IndkS`111............ .......... ........ ......... Phone No: ...... 0.6113.nl ...........................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: .....&_..9....... :t.�a�.....1.nt.......................................................................I/ 9ulSanal..t....N...C..................................... ..% .........
Onsite Representative: ................ %NJM.C.1......... J[N4Y\.15�1................................. Integrator:........... . �....It's..................................................._.
Certified Operator. ............. ( �..9.6xk...._Operator Certification Number,....... ..............
Location of Farm: J
Latitude ®• FOL., ®" Longitude FED ®' 3— «
n _
Destgn Current e r Design Current = 'Design -Current' `a
Swine � Capacity Population Poultry Capacity�.Population - "Cattle', Capacity 'Population
Wean to Feeder 3S' - 7- 10 Layer I Dairy
;.. ❑ Feeder to Finish ILI Non -Layer I I JLJ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder - ❑ Other F �"
❑ Farrow to Finish n
Total Design Capacity n; 3SSL
❑ Gilts
❑ Boars Total SSLW
Nfiiiib6edfLagaonsIH61di_g Ponds . ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Feld Area ,
ti n"
u
❑ No Liquid Waste Management System'
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
1�3 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
f No
c. If discharge is observed, what is the estimated Flow in gal/min?
)j
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes]
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
1 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
EP No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
4 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

�Facilify Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagonsZoldine Ponds Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (ft): ..............I ..1..............
10. Is seepage observed from any of the structures?
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 WMP, or runoff entering waters of the
State, notify DWQ)
15. Crop type ............................ �J¢ rllrr?.4..................... StYri11......��'R-11......... ........... ..................................................
16. 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?
O•No.violations-or defideiidis.werenoteddtiritigthis:visit. Nou:willi-tie ve•ito•ftirtlier:
correspotidehce about this:visit:
N eY\ s�1) motk.
NUC-Or ov"� \k,ci-ct-- Or .1 —` it smct�l �vc yet � 'IIbt/ac,
❑ Yes
No
❑ Yes
No
Structure 6
...................................
....................................
❑ Yes
fA No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
M No
❑ Yes M No
❑ Yes E No
❑ Yes P No
❑ Yes W No
❑ Yes T No
❑ Yes W No
[� Yes ❑ No
❑ Yes ( No
❑ Yes No
❑ Yes No
7/25/97
Reviewer/Inspector
Name"
, �*
',, Reviewer/Inspector
Signature: •B,n
�.�
�)
Date:

10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection I(
Facility Number 3 1'I
1C1C Time of Inspection 3`®-� 24 hr. (hh:mm)
E3 Registered 19 Certified 13 Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated;,,,,,,,,,,,,,,,,,,,,,_._
1,I L ` I, �
FarmNante:........ ipA%C..l....... BA.I......... �.4..a................................................................... County: ......11l( .�!t..............................................................
Owner Name: ....... L�....... SI'W.Y.lk%....... .............................................. I......... Phone No: ... 0164.2-A.S.:n3ir...........................................
Facility Contact: ..... .. IlN1t11.......... �..CYtkt}.t1�S.......... Title: ..... D141C.......................................... Phone No:��11G).. !..-..1�...........
Mailing Address: ........111_.9......... .......�r................................................. .........
Wwrs 1a1...AR', ....................................... .... lwx..
OnsiteRepresentative: ...... lxo%y............ 4yxiVV. ....................................... -•Integrator: ...... CAY"1yt.l.........................................................
Certified Operator:.........&!fL............Sr........ j.V11AOperator Certification Number, ..5-4......................
1.1�........................
Location of Farm:
LA ...........yi.... W14k...... . ua....Z'.!k9..u<?..1.k?ursat?....c.Fx4 ..TV.!rm...r.:t4 ... 0..... S.i?..11a8.....ty n...ri5. ...ar....:................
..an.._if�.!_3`%.....6A m....Cs.....Q.:Sm.UX.�......pasi....so'..Ii ...Q. .rsr
Latitude =• =, 0" Longitude =• =` ="
Design Current r�Destgn Earrent,' s Design; -arrant
Swine 's = Capacity' Population Poultry Gapaciry:Population „ Cattle Capacity Popti iiion,�.;
Wean to Feeder ❑Layer `_ ❑ Dairy -
`. ❑ Feeder to Finish ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean - -
❑ Farrow to Feeder ❑ Other.
❑ Farrow to Finish Total DesigneCapadty' f
❑ Gilts p
Boars
s"�.TotaISSLW"� C'
F
Numbe[-of lagoons / Holding Pond`s -�'' ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area a
x
%0- ❑ No Liquid Waste Management System x r s
General
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 M No
❑ Yes ® No
❑ Yes &I No
❑ Yes R No
❑ Yes 0 No
❑ Yes PNo
❑Yes tgNo
14 Yes ❑ No
❑ Yes 5d No
❑ Yes @ No
Continued on back

Facility Number: j I — )
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 10 No
Structures (Lagoons holding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(ft).........Z:-g.....................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes IJ No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
EANo
12.
Do any of the structures need maintenance/improvement?
KYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
11 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ............... tkV"&.................. .................................SMO.... 3mlyn ............................. .......................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
gj No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
19 No
18.
Does the receiving crop need improvement?
- ® Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
f N No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
Q No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EdNo
22.
Does record keeping need improvement!
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
P No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P§ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
Y No
No.violations iir deficiencies were noted during this.visit .You.will receive no further
correspondence about this visit.
Use drawings oifacitity to betterexplain situations. (use additional pages; in essary):n r ' F
s`, 1,)etri •Etrt,ts tin sp�rd,1 �tfJs s4wi.ld ba rcMovc�, (rrtt,,a'�iG, �ipc• a1�hJo bytdye S�nat�� �Oe. c
o,, 161cos, S1mUIJ Ise r seeJ4.
It• �ttrodl �ra�h �iank� o,. (1��j97.
2z, IR0. z 6rw, sl edldtc.4er Fo Ur, ?dsiiton and ac 1tov- ok t"c - f-s1P%t� et/+. , All
SpVvj pd5�046rs s�n 6 64 rna VT I' Was4 (Ln0.�s,s 5ho4 toe t,Pd0.[-l.U•
7/25/97
Reviewerlinspector Name
Reviewer/Inspector Signature: rmw,__ Z, Ah Date:

3
Site Requires Immediate At �Z
Facility No. —
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD 31 � � Z9
DATE. EYE?) 1995
Time: I O YD
Farm Na
Mailing
County:
Integratc
On Site kepresentanve:
N)
Phone: d`1 ) — S `tJ `I Lw)
Physical Address/Location: ; yja 1 3 t-1
Type of Operation: Swine _L--' Poultry _ Cattle _
Design Capacity: '3 S Y d Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3S Oa '08-q Longitude: -it O" Elevation: —Fee t
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) 6e or No Actual Freeboard: `'E Fc Inches
Was any seepage observed from the lagoon(s)? Yes or io Was any erosion observed? Yes or
Is adequate land available for spray? es r No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orQ10 a(.jr-j,
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(
r o If Yes, Please Explain.
Does the facility maintain adequate was management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? A or No
Inspector Name Signa e
cc: Facility Assessment Unit
Use Attachments if Needed.