310219_INSPECTIONS_20171231

NORTH CAROLINAAM
Department of Environmental Qual

'44
for Visit:
Date of Visit: I (D
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Review
Referral Q Emergency 0 Other 0 Denied Access
Arrival Time: © Departure Time: ® County: Region:
Onsite Representative: N C ^ t f `- ' `Le a
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: ' k-0 p /
Certification Number:
Longitude:
sh
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cowder
r7T
G 9 D
Non -La er
Dai Calf
ish
ean
Farrow toTinish
r,
Layers
rHNon-Layers
Design
Ca aci
Current
P,o ,
Dai Heifer
D Coweder
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Beef Brood Cow
Other
El Other
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 eNoo ❑NA ❑NE
❑ Yes ❑ NA ❑ NE
Page I of 3 214120I5 Continued

Facility Number: - 21 1 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2
Identifier: -2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 ( 4 (—
Io ❑ 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 0<0 ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ 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 e5No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E5No ❑ 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 [Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �I
❑ 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 Cj No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [?(No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available? ❑Yes ❑ 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 e120 Minute Inspections ❑ Monthly and N 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 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

IJ. Facili Number: Date of Inspection:
24. I jd the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Ion -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 ZrNA ❑ 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 the 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 ZNo ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better explain situations (use additional pages as necessary).
C ,t e4.•A �11 Z
21 s 2° Lo 64C a„ ' SS��
2.5. S IFA4 jc (« I S w-C- k*• I% Six l o� s.,.t,tiyy L�r7
n•Ao�
,,,� /hw�J11 a-�C_ PO4. 1_
Gcf �Ppr o� S16�� OKT Sti/Y'A'r"Ilt Jglkew
Reviewer/Inspector Name: 1040W U., �./�� �"j� II/1�N�.e�. Phone: 7
Reviewer/Inspector Signature: ,i✓1,2 Date: /
Page 3 of 3 2/4/2015

i11
Type of Visit: Q Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine O Complaint Q Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: $' Arrival Time: Departure Time: 52�2= County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: X6A ( TA16
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design C+anent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
QW P,ouItr,
Layers
Design
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
its
Non-La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
OtherI
NJ Other
Turke s
Turkey Poults
jOtber
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 �o ❑ NA ❑ NE
[:]Yes [—]No
❑ Yes ❑ No
❑ Yes �o
[:]Yes o
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: ZZ _ Date of Ins ection: $
Waste Collection & Treatment
4.'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � ❑ 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: to f 66ttJ L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the of any of the structures observed? ❑Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental rent, 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? 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 ❑ Yes VNo
❑ NA ❑ NE
maintenance or improvement?
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
gN
❑ 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
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?
❑ Yes
)Fi ❑ NA
9NO
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 ILI [3 NA ❑ NE
❑ 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued
r

Facili Number: Date of Inspection:
4
24. Did the facility fail to calibrate waste application equipment as required by the permi ❑ Yes E ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ 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
Ng
❑ 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
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? ❑ 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?
❑ Yes
%/ ❑ NA
N6 ❑ NA
No ❑ NA
der to, question #): Explaiwany YES answers and/or any additional,recommendations or anyother comments.
of facility to better explaitf situations (use additional pages as necessary).
Ld�)k XVba YwplGc IFMOVK L
Reviewer/Inspector Name:
❑ NE
❑ NE
❑ NE
�glSf
Reviewer/Inspector Signature:
Page 3 of 3
Date:

11
for Visit: (3f Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /_ t� f pJl l Arrival Time: Departure Time: 1 D b County:'TAi Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 9,M")T tA=C fl 4 ,t . Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 18 Q a'3
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
C•unrent
Pop.
Design
Cattle Capacity
Dai Cow
Current
p.
P000m
Wean to Feeder
I
INon-Layer
I
alf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . • P,oultr.
Layers
Design
Ca aci_
Current
P,o ,
D Cow
airy
Beef Stocker
Its
Non-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 2�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
tyo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3
21412015 Continued

Facifl -Number: - Date of Ins ection: $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A&aao
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [Z"No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑iN'o ❑ NA ❑ NE
maintenance or improvement? 7
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CNo ❑ 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
[D�No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
5<0
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ 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
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
Nin
❑ 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 ❑LeaseAgreements ❑Othe
21. Does record keeping need improvement? If yes, check the appropriate box below. 2 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 01waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2 N/ � ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: pppp 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [ NNo ❑ 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? No
❑ Yes
L
❑ 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
13<0
❑ 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
C3 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
Ej 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 [2No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ETNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Zo
❑ _NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �
❑ NA
❑ NE
Comments (referdo 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).
�j l) wwM ANA0'- 04:T5S7a16- - OP—
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phonegjb 7 `b'
Date:
21412015

Type of Visit: Cd Cgfnpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: t01 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: q ( Arrival Time: ® Departure Time: [ County: �uP�j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: KC2;1[� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: MCI 93
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
I
Wet Poultry
JLayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
'i0
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Design
upaci
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBecfBrood Cow
Other
Other
Turkeys
Turkey Poults
Other
Hj
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes Io ❑ NA ❑ NE
❑ Yes [2/No ❑ NA ❑ NE
Pagel of 21412011 Continued

Facility Number: Date of Inspection: S
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 1 Structure 2 Structure 3
Identifier: LL02 MQ(- 1 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
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 PIo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑ 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 Ld "V
❑ 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 AIo
❑ 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 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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[� No
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ca'/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes�(NE
❑ NA
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EfN o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check jlte appropriate box belo
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
LQ "
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNo
❑ NA
❑ NE
Page 2 of
21412011 Continued

Fatili Number: Date of Ins ection:
24: Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ETyes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes LE�rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o
❑ 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
19 `VU]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
— /
hIQO
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
ii7
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Qo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ Q o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑'[ o,
❑ NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
EN
❑ NA
❑ NE
Comments (refer to'question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional paces as necessarv).
VLM5s (,, 106 WASTE AuAI,YUU5 50-a- f T MS55tc�.
,)wuE2 mtl-i NAJE gZco"S Obt/e ouruDC To FAX j Ceco"SS rof JjfCLD'
1?A4 �6� (XC, e-A2D UAJE N61" v c. Ce�/Go'
Reviewer/Inspector Name: �{.},j�,ti fAVM(btt,,
Reviewer/Inspector Signature:
Page 3 of 3
Phone: % [ (j --7 7 gp
Date:
21412011

(Type of Visit: i) Corypliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
4-0/RI
Reason for Visit: 4-0/Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 15t Arrival Time: ETD—)] Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: k,Fi A Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: 1g b'Y3
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
I I La er
Design
Capacity
entm
Pop.
esign Current
Cattle Cai--acLt—
yM p.
Dairy Cow
Wean to Feeder
-55
&.600
FTNon-La-ye-r-T
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oult .
La ers
Design
Ca aci
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBeefBroodCow
Other
Other
Turke s
Turke Pouets
Other
EA
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 Ido ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes [—]No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ YesVN�o
�
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Page I of 21412011 Continued

Facility Number: Date of Inspection: 1
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
❑ 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: LAComt3i IA�OW
Spillway?:
Designed Freeboard (in):
C
Observed Freeboard (in): t�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
do
❑ 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 d� ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ld 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 do ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CeNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes D No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�Je<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[D4
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
l
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
oo
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q
❑ 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.
0Yes
[—]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
Q No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Io
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection. k7, 3
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesETNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No
❑ Yes �No
❑ Yes 1 11O
[—]Yes l? "o
❑NA ❑NE
❑NA FINE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2 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).
'L(,) 50L(-. 5M-kPt_t` LAIC Fd(L 2_0tZ . TAKC AQ6 7 Nc-ru�- SFcy >pL_-
C►.1D O-C ye-aa. Fo6L ZAr3 , (�LGz, (3E CASkFt_)C, O�
TSrnE`� wA�TC- 4NAL-4<ss. K—fceP LT- c TSC1<E�
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone:lglirj_) /q%-73Q0
Lj9►�� Date: S
21412011

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: g t. Arrival Time:© Departure Time: p® County: bL),Q Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 1S ES-(}4 Cyp P.)Es Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I t D$ 227
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Pouitry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Wean to Feeder
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,o_ult ,
Layers
Design
Ca aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
—TurkeyPouets
Turkeys
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Yo
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facie Number: Date of Ins ection: IZ�
Waste Collection & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ef'No
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No
Structure 1 Structure 2 Structure 3
Identifier: I A 1,0,2. ( (.IQ• &COA1 L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L-3
❑ NA ❑ NE
❑ NA ❑ NE
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 0 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 [DNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6 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 WNo [DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 21 No ❑ NA ❑ NE
maintenance or improvement? /
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ICJ 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
❑-Ro
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
M'Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ONo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ld 1V o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E340
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspection ❑ Sludge Survey
❑ 22. Did the facility fail to install and maintain a rain gauge? Yes b ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facihty Number: 1 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1__I ° ❑ NA ❑ NE
1
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Ej No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6 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)
❑ Yes ENo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑Yes 0No ❑NA ❑NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP? ❑ 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? ❑ Yes
O
NA
NE
1Vo
❑
❑
[7No
❑ NA
❑ NE
r❑
NA
❑NE
o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).'
IS.� /JE�,D LS_*AE �=��S. t<EE-� %; car to S4ot.l Do�c .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
AJ 0�"LL'-- Phone:�q(i t lb —'� w
Date: 2/
21412011

n Division o(W.!er Quality
' Facility Number �� oL� q O Division of Soil and Water Conservation
0 Other Agency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other -�-,❑Denied Access
Date of Visit: 1 Arrival Time: Departure Time: County: Region: _
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
i
Onsite Representative: 'KLI14A l fol la
Owner Email:
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = U = ' = 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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[3 NA
❑NE
❑Yes
❑N
❑ Yes
1� No
❑ NA
❑ NE
❑ Yes au ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
1
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: C Af Udcomi3 7i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): So
1.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes M 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 t reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ,._J/No ❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Ye
I� N [I NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EYo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ 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)
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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ NA ❑ NE
❑NA El NE
❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Yes 23 No ❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any recommendations or any other commentstC
,Use drawings of facility,- to better explain situations (use addrhonal pages as necessary) y �3timx,
Reviewer/Inspector Name U(/ w> 4 h Phone: —73
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 ontinued

Facility Number: -a Date of Inspection 1
Required
Records & Documents
/
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
[I Yes
[
No
NA
El❑
NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
..J/
E; 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
El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
24o
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El es
Zo
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
o
❑ NA
❑ NE
Otherlssues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElL�rvO Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B/No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
YNo
❑ 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
OrNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require afollow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

N/ Drvtstowof Water Quality a ^*' r ` �, �
Facility Nm uberalcl O Divisiomof Sod and Water Couservatton `� v
ti
"�.`OtherAgeucy,.,.
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other \ ❑ Denied Access
Date of Visit: y 7 10 Arrival Time: 9OD Departure Time: County: QiQ r.� Region:
Farm Name: _ _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: kEst� .To1.1Etj
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , Longitude: = o = ,
Design Current Design Current.Design Current
Svime ` ; x Capacity Population., Wet PoultryCa act Po "Mahon `Cattle ` ` �`�` `C"a`ac Po ulation
P tY P P tY k"+..-au.. P tY P....�
,.-_.. �...P
❑ Wean to Finish
J0 Laver
; ❑ Dairy Cow
Wean to Feeder
1(,100
❑ Non -Layer I
I
E]Dairy Calf
❑ Feeder to Finish ;,..,.:�:"';"`;k,'4;"w.. ❑ Dairy Heifer
❑Farrow [o Wean �`` `# ❑ D Cow
��,.` _Dry Poultry a
q
❑Farrow to Feeder '' "` '" ""` `'�`'''' ❑Non-Dai
A
't❑ Layers
❑ Farrow to Finish t ElBeef Stocker
j ❑Non -La ers
El Gilts ❑ Beef Feeder
El Boars " El Pallets Pullets -
Beef Brood Co
? ❑ Turkeys
Other ❑ "�
^,�' Turkey Points
t:
*�
❑
�% ❑Other
`
of Structures
Other
^'Number,
r
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 LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
El NA
[I NE
❑ Yes
❑, NN
❑ Yes
L'J7�No
ElNA
ElNE
ElYes
Lid No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

r Facility Number: Date of Inspection LO
Waste Collection & Treatment --//
r 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ " o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA6m, 1 LAG-202J Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[�No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
LY<u
❑ 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
WNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�YNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
/
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[I NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�PrNNo
1(� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q&
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[d`No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/,or''any recommendations.or any other comments x �,
Use drawings. of facility. to better explain situations. (use.addtttonal pages as necessary)
L1C-E,ID to n4A1cC- SU2k &'C-T W-0 1.0UP Vors_ OcL_> LA.>o "4IS 43E QUwt-PE D of
Apo (,,r_ASr-0 LAOD Nord cxwlOW4 Do n1aT Qu"%Af U'-JTV _ ZOrJE,
ak•) WASTC ANAL1?5Z5 iJOT 1AV_C-V3 -TO "04. 7'41m% 9uw49Sro(,.t pVo(- Doe-W
Nov -IDC�C 2a31 • of C'0 I-1.>rC_ NE2 PAO {R arvL Wl►tift ?Atp AvJALti SAS.
PtjkW PAV ATtxr.)-Tte-0 At3 0 —)Ake SAry-�PQE- EUCR__Y 3rvwlJ11iis,
IReviewer/Inspector Name I 6 ' Vjl , '
Reviewer/Inspector Signature: �Ialplj. _sa6 Mq zg Date: L4 )
Continued

S, Facility Number: ' \ —ouci Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard dwaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L1No
❑ NA
❑ NE
[]Yes
u No
❑ NA
❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
❑ Yes [;(No ❑ NA ❑ NE
❑ Yes EiNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
ElYes E No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes t_J &o ❑ NA ❑ NE
❑ Yes
CJ No
ElNA
❑ NE
❑ Yes
E: No
❑ NA
❑ NE
❑ Yes
0<
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit (25 C(9tnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y 8 09 Arrival Time: ® Departure Time: County: DvP�— Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
i
OnsiteRepresentative: kcyrs le es
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = U ='
Q Longitude: = ° =
Design
Current
Design Currentiiiiiiiiiiiiiii
esign
Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle
Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
® Wean to Feeder ULQ-/J
10 Non -La er I 1
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
La
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers
El Beef Stocker
❑ Gilts
❑ Beef Feeder
El Pullets
❑ Boars
❑ Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes Plo ❑ NA ❑ NE
Page I of 3 12128104 Continued

' Facility Number: — q Date of Inspection
$Waste Collection & Treatment ,�/ /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA(wwr'.1 ( �A6t5v✓ 1—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `fit-{ aa9 .
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E 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
T Do any of the structures need maintenance or improvement?
❑ Yes
0
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
7No
❑ 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
V No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E� No
[I NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
Yes
El{E
NO
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
1(,) FAfL e,61L-5A"90E To
r)(,JQ
Reviewer/InspectorName I i,/ _11Phone: 10
Reviewer/Inspector Signature: Date: qlg 6
n___ 1 _r n 17/9R/fill I /'nnlianad

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

6Divdsion
/
Facility Number
of Water Quality
O Division of Soil and Water Conservation
J
O Other Agency
Type of Visit corl�pliance 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[I Denied Access
Date of Visit: c( O Arrival Time: �O't
I
Departure Time: County: JbV(.E1,1
Region:
Farm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: 04L114 . fa rd E.f
Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm:
Latitude: o = ' = « Longitude: [� o
= ' M
Swine
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
G (p jo I 10 Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurkey 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E3 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ N
❑ Yes
❑ NA
❑ NE
❑ Yes LI No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Z�
Date of Inspection l o
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: L44 (�*A/ / -CA (7a&J Z
Spillway?:
Designed Freeboard (in):
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 l d No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes 2/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑YesZ
❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ElYes ONO
❑ NA ❑ NE
maintenance or improvement?
Waste Application ,_,(/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EI No ❑ NA ❑ NE
maintenance/improvement? ,.,.,//
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes I[d No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ❑ NE
❑NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: _
12/2RAM

Facility No Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L7 No ❑ NA ElNE
ElWaste Application ElWeekly Freeboard ElWaste Analysis ElSoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections
������,,,,,,////❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ,�(Tj�0 ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Ea No ❑ NA ❑ NE
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
0 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑yes
�
❑ 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?
El Yes
,,�
n 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
El Yes
(/_
M 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
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or
12128104

Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation ..`ate
O Other Agency
Type of Visit (Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance J
Reason for Visit CO Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of VisitEsTlo-51 Arrival Time: IOU U Departure Time: County: D..Pt,vJ Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: jt. C 1 1 A J GIVE
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [o='= Longitude: Q°= [�`.
Design Current Design Current
Swine Capacity Population Wet Poultry .Capacity Population
,k. ❑ Wean to Finish ❑ Layer '�JQ Wean to Feeder I ✓0400 I el000 I JONon-Layet
Dry Poultry
Other
❑ 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?
Cattle
El Dairy Cow
El Dairy Calf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
El Beef Stocker
❑ Beef Feeder
❑B fC
ee Brood0
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E I No
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection 4 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
U/ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LA(Yoar+ I LACY-00 L
Spillway?:
Designed Freeboard (in): Iq, �T My
Observed Freeboard (in): al oj�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No Er
ElNA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ffNo
❑ 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?
CJ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Ld
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑Yes D"rvo El NA [I NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes IQ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application El"
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L-A No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes La 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 Drifi [:]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
L-3 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
2fTN
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,L�'1/No
L/J No
❑ NA
❑ NE
IComments (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):
q.) oat Wo21c. N(EoE9 oN L1Goont I .
WA ST( ANAL YSX& 06'r CefAa- w aY ;j✓0E )W(o , 4ttASE 0,6 K402E 7rtotr t®T,
LO(At C AV(MC-C S(ac.lciH(G Ffti 2ao(., -U C44e a,.att-0 XNGL.r1DE IZo i c.P—)ff
2r�ut;I,J LeASE Atr"F_WEnrr t3C4r6A_C NmPIN(r 6W t-APD.
Reviewer/] nspector Name C104iAkik-1L Phone: C9/0 7q&--1
Reviewer/InspectorSignature: UM AVLAAJ P Date: s15 b `l

'Facility Number: 31 — e1 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps [I Other _�/
21. Does record keeping need improvement? If yes, check the appropriate box below. eyes ❑ No ❑ NA [:1 NE
❑ Waste Applicat� n ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall Stocking u Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections E] Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Lf No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes eNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,El"No ❑ NA El NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes I_I No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No 2fNA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
❑ Yes 94O ❑ NA ❑ NE
❑ Yes 9NO ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 1T No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
Page 3 of 3 12128104

'acility,Number 2,
Division of Water Quality
Division of Soil and Water Conservation
Other Agency
Type of Visit ,C[ympliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: V db Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: K 4s�ai . /ehIES Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [= o [� ' = Longitude: [= o [= ,
`
Design Current-
Design Current
Design Current''
Swine
Capacity tyPopulation Wet Poultry ry
CapacityPopulation-,: Cattlez
tyV__ oQulahoo
'd
❑ Wean to Finish
`'-J❑ Layer
❑ Dairy Cow
Wean to Feeder
J❑ Non -Layer
I
I
E]Dairy Calf
I'^
"-. ❑ Feeder to Finish
❑ Dairy Heifer
❑Farrow to WE
Dry Poultry
❑ D Cow
w-
. ❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
' ❑ Layers
�,,. ❑ Beef Stocker
x ❑ Gilts
❑ Non -Layers I
� El Beef Feeder
s
❑ Boars.
❑Pullets
❑ Beef Brood Co
F
---- --- --- --
.:.Other
❑ Turkeys
---
-,
❑ Turkey Poults
4
❑ Other
�-_--
❑ Other
Number of Structures 1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑/No
❑ Yes
_
� No
❑ NA
❑ NE
❑ Yes
1.2<0
❑ NA
❑ NE
12128104 Continued

Facility NumbDate of Inspection 3 ��
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: l.P (w,00^) ( LA G-W AJ 7Z
Spillway?:
Designed Freeboard (in): 15 l 1,
Observed Freeboard (in): 3 a-' a2 ;
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E6No ❑ NA ❑ NE
❑ Yes ONo ❑ 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? El Yes �N El NA [I 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 Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E3"No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ 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 ElApplication Outside o/f'Area
12. Crop type(s) VJA S A 3t�ft.,w,JOQ l��- 0 GJS
13. Soil type(s) C-'a�SgVrV_a ►4lm>,-jl✓r� 4 r=
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;'No ❑ NA ❑ NE
E No ❑ NA ❑ NE
VL&IEl NA El NE
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
rAR-vl, L,"its c 6". wri F KZ-t �(AYLUE.ST a& Z)tL- 't-o
R�com D crwo q a(-' %4
5ccr L, S A rACL S C t.Jr 9-r=S J0T5 -JOr (3ACI
IReviewer/InspectorName JDN A t 1 Phone: iIU I /'YG-7 3-
Reviewer/Inspector Signature: QTA. Date: 3 /(9 0 S.
P.. ), of 7

Facility Number: 'j t Date of Inspection 3 Ca o(o
RequiredRecords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections [:]Monthly and V Rain Inspections ❑ Weather Code
❑ Yes
[, o
El NA
El NE
❑ Yes
[ J No
❑ NA
❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C1 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
❑ No
VNA
❑ NE
❑ Yes
❑ No
ONA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
❑ No
D<A
❑ NE
❑ Yes
LJ N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ErN/o
❑ NA
❑ NE
❑ Yes
El NA
❑ NE
❑ Yes
,EjNoo
L7 N
El NA
❑ NE
❑ Yes
❑ NA
❑ NE
Page 3 of 12128104

IType of Visit .0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
IC7/',y////J���j--
Arrival Time: ; Departure Time:
Q
County:
Farm Name:
--I
Q r:T- '! lY1 Jr
Owner Email:
Region: Wi/PD
Owner Name: �ifG�O/✓ !�:- c=J00✓ES Phone: �&a3:�!5n A
Mailing Address:
Physical Address:
Facility Contact: Q�Title: Phone No:
Onsite Representative: T���-: �/�/' 5 N % /' 'rr In tor: A91__nS e
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = U = . = Longitude: = o = ,
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer [Q 00 ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
❑ Pullets
❑ Turke s
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
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:
J
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 YJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
El NA
El NE
El Yes
y No
❑ NA
❑ NE
12128104
Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment / ✓/'� J
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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: fj
Spillway?: ��C
Designed Freeboard (in): /n9. A • 7
Observed Freeboard (in): /i 8 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
8. Do any of the stucmres lack adequate markers as required by the permit? ❑ Yes o No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes I/J No ❑ NA ❑ NE
maintenance or improvement? /
Waste Application rrr���111
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes y� No ❑ NA ❑ NE
maintenance/improvement? / 1t
11. Is there evidence of incorrect application? If yes, check the appropriate box below. �Y eso ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /)jq (v-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/,LI 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
)Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C�'No
❑ NA
❑ NE
I
Zf 74;-& � / el rf�✓(i/—'O C%le I2128104 Continued
� G/7-/os

ti
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
e.
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 1 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking VfCrop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
P Yes Cl No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
J0No
V(No
❑ NA
El N
❑ Yes
/No
❑///NA
Lo
IE
El Yes
❑ No
12 NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
El Yes
r��,{t
y� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
;XNo
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
5vu '; Gt%41E,4,
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//xo �,3
5
12128104

of Visit OCompliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification O Other
Facility Number H=ZT
Dale of Visit:
0 Permitted E3 Certified [3 Conditionally Certified 0 Registered
Farm Name:
Owner Name:
Mailing Addn
Facility Contact: Za4p4),tLs 144rJr.,,>...... ....... .............. iiue:.._....__.---J--/-.
Onsite Representative: af...^j�PSy
Not
❑ Denied Access
Date Last Operated or Above Threshold: ..._...... -_.......
County:
Phone No: ... ......................
............................... _. Phone No: _._...............
--- -- -- -- ....
Integrator:_
Certified Operator: ....................... . .......... . .......... . .. __... ........... .. Operator Certification Number: ..................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =if Longitude =• =° =11
Discharges & Stream Impacts _
1. Is any discharge observed from any part of the operation? ❑ Yes kj tvo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Struct e I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ._. �............. ........................................ ---._..._.__.._..... _....
Freeboard (inches): ,y (p "?Jj
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes-ZNo
❑ Yes eNo
[]Yes 0
Structure 6
12112103 Continued

Facilrry.Number: — Date of Inspection i L
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes Ergo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes Jallo
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 maintenancelimprovement?
❑ Yes ,21Qo
8.
Does any part of the waste management system other than waste structures require maintenancelmprovement?
❑ Yes O'No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ,`No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes 014o
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes ,0 No
❑ Excessive Ponding ❑ PAN ❑ Hy ❑ Frozen Ground ❑ Co r and/or 'nc
12.
?cerload
Crop type S� Ov
13.
Do the receiving crops differ with those de ignated in the Certified Ammal Waste Management Plan CAWMP)?
❑ Yes ZNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ZNo
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes ZNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes (ZrNo
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes JZI 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 12rNo
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes ZNo
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes )9No
Air Quality representative immediately.
Field Copy ❑ Final Notes
0*W4veAE_ rt Rlv\r-77,
A%fEp o ��FFc� %m SEN .ZF AGPLzc�� �e.v G(/qs Set, f, z�
Ak U)4'5 e- 441-9(525 0 jo /PL
✓
piny 2003 .
<,t�F Silo is F Fd
Fr,94 kT�kt,05. A)O f
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12112103 Continued

Fad!ky Number: —'jam Date of Inspection �t
Reauired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
)ayes ❑ No
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 O'No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes,)RNo
❑ 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 0 No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes ,ErNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes Ergo
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes J'No
28.
Does facility require a follow-up visit by same agency?
❑ Yes .Elf4o
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Aa<o
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes -Q-NB5
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 V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit to Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit o Routine o Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted 0 ertified D Conditionallyy Certified 13Registered
Farm Name: 2T ff lMa 17-5� FryemI
Owner Name: L e r </i 25��
Mailing Address: -
Facility Contact: -
Onsite Representati
Certified Operator:
Time:
Date Last Operatedor Above Threshold: _
County: NpGz�
Phone No:
Phone No:
Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' =` = - Longitude =a =I =
Design Current Design Current - Design Current
Swine. Capacity Population Poultry Capacity Population Cattle ' Capacity Population
Wean to Feeder I I ❑ La er ❑ Dairy
❑ Feeder to Finish ❑ Non a er Non -Dairy I
❑ Farrow to Wean 0 '
❑ Farrow to Feeder " ❑Other _
❑ Farrow to Finish Total Design Capacity
❑ Gilts
y
❑ Boars Total SSLW
Number of Lag
oons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ra Field Area oons
.. _
HoIdiot; Ponds % Solid Traps 3.µ0� ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )ZNo
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 Bow 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 rrr9No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes y� No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
St}rcture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: G�
Freeboard (inches): Z�
05103101 Continued

Facility Number: 3 — Date of Inspection 10
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
ONo
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
r-�
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
j�No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
o
11.
Is there evidences of over application?? ❑] cessive Po ding ❑ PAN ❑ ydraulic O/vj�load
//�� ❑ Yes
/ No
12.
1
Crop type �F (/]/'�� / f}5T11W6 1 . v / t�� yj/�t�f'..��
-1, (N/`,L�Y
13.
Do the receiving crops differ with those designated in the CerfifiedAmmal Waste Management an (CAWMP)?
❑ Yes
ONO
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
PfNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
ZNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
,_.,/
Ld No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/1
(ie/ WUP, checklists, design, maps, etc.)
El Yes
�1l No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
,V� o
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Did the facility fail to have a actively certified operator in charge?
El21. Yes
No
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ONO
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�No
24.
Does facility require a follow-up visit by same agency?
El Yes
�No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
y6_0;'A�
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
;Comments (refer to question ti) :Ezp�arn'�(anvyYES answers and/or any Fecommendations or aoy,ot er comments. , s� ' "
drh4iigs to explain addihotiaPpages as
Use of facility better situations. (use necessary)
•:e:.., r .. a'sCx-s a'� :§ - w "4, a:' 1, I,... „ _ „� 4
Field Copy El Notes
IS> E Sul �/tK� fis9� /}LSLS
o LedflZ �-
7 CO✓EK '1>oa_� ��G2cf}TZDnIS,
7O �)1
� E �L S ��T S A0
CfJ/�FZ S fL ww� PIY4£ 5
/ a<
Ji4
Reviewer/Inspector Name I
ReviewerAnspector Signature:
Date: O
05103101 `� Continued

Facility Number. 3 — Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
1(J 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; „.- jL,
05103101

of Visit (gCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 21 Date or Visit: Z 07- Time. �
0 Not Operational O Bel,
(*Permitted 13Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Tfireshold:...........................
Farm Name: ......... _�GNnO. ........�........rR..C7.Y.................................. county: ............. 31.iy4i.�1............................ Nt..........
v`/ ' ,t s
OwnerName: ..............L.l_ ...................... Q.......................................... /Phone No:.......................................................................................
Facility Contact: .....�LJ•`Y. .........._ .Qk:.%: ................ Title: ......._6.41i+!Y.................................... Phone No:....................................................
MailingAddress: ............................................................................:........................................................................... ....................................................................
OnsiteRepresentative:..{.1:'S."....p.�l:�.!'.L.........SIQ�.S........................... Integrator:...........
Certified Operator: .......
..... _ .................................... .............................................................. Operator Certification Number:.........................................
Location of Farm: I
)Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =0 =• =11 Longitude =- =1 =«
Design Current Design Current Design " " Current
Swine Ca acity_ Population Poultry Capacity Po -ulation Cattle - - - capacity Population
Wean to Feeder ❑Layer ❑ `, Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder 10 Other I-
❑ Farrow to Finish Total Design Capacity "
❑ Gilts
❑ Boars Total SSLW, s:
Number of Lagoons +© ) ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdmg Ponds / Sohd Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ANo
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? —A/n —
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
U(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
C(No
01/01/01 Continued
1

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4.
Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
[]I No
SJJ��.,,,�uu,c�tu��re I Structure.Structure 4 Structure 5
Structure
6 ,\
.Struu/ctureL2
Identifier: ......1...:.3!.!.:!:�........ . �J..��.C........ ._.... _.............. ..................... .............. _........
.
_........ ... _..............................
Freeboard(inches): ............ .................... ............._a,/...................._........................................_.....................................................................................
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
K
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
No
8.
Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12.
Crop type
f)1�. '�116y��
C
W
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
❑ Yes6zo
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
,47�Are rock outcrops present?
_,B'Is there a water supply well within 250 feet of the sprayfield boundary?
Required Records & Documents ❑ On -site ❑ Off -site
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes No
❑ Yes No
❑ Unknown ❑ Yes ❑ No
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
23. Did the facility fail to have a actively certified operator in charge?
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
26. Does facility require a follow-up visit by same agency?
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
❑ Yes ICY No
❑ Yes XNo
❑ Yes XNo
❑ Yes KNo
❑ Yes Po
❑ Yes XNo
❑ Yes *o
❑ Yes JKNo
❑ Yes No
❑ Yes �(No
29. Are there any dead animals not disposed of properly within 24 hours?
O1/01/01
❑ Yes VNo
Continued

Facility Number: — t 1 C1 Date of Inspection 9
30. Is there any evidence of wind drift during land application?? (t.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Printed on: 1 /4/2001
❑ Yes 0 No
❑ Yes P(No
❑ Yes ANo
❑ Yes xNo
❑ Yes kNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) Ezplatn anyl-YES answers and/or any recommendahorwor. any other comments
U�_drawtngsof facrhty to better explain sttua4ons (use additional pages as necessary) � Field Co Final Notes � 1
Far Wl IS W"A IMV
Reviewer/Inspector Name'.-
Reviewer/Inspector Signature: Date: Q
01/01/01

JW Routine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review0 Other
Facility Number Date of Inspection/
Time of Inspection ll' D 24 hr. (hh:mm)
(1l Permitted E3 Certified 0 Conditionally Certiried 0 Registered 0 Not O erational ate Last Operated:
—{�' P ..............�...............
Farm Name: i
`.\.�1LUlR...............V............._.Y.:M.�t......................... County:.................�.........................Owner Name:...........`�%...........................�\.,.d�.±rS.................................. Phone No:.......................................................................................
Facility Contact: ..�wS.,4 ........�� .�[ila,l..$.................. Title:....Q.W?.�Ae................................. Phone No:...................................................
MailingAddress: ........................................S...........................(..�.........................�.......i..i...C....l...t..,.,..�...,..�.....I..n...t..e..g..r..a...t..o..r...................... ..........I...1'............r..........
M.............1..........
Onsite Representative:......................... ... .. —i
Certified Operator: ................................................. :.............................. ................................
Operator Certification Number:..........................................
Location of Farm:
Latitude =•=, =« Longitude =• =' =16
Design Current.
`.Swine Cauacitv'Pooulation
Wean to Feeder
I U
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design .
❑ Other
Total Design,Capacity.
Total SSLW+
- ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
❑ No Liquid Waste Management System
Ulsctrarges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes C(No
Discharge orieinated 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? (II' yes, notify DWQ) ❑ Yes []No
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a ]agoon system? (If yes, notify DWQ) - ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes >QNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [� 'No
. Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 -
Identifier:
Freeboard(inches): ............. .................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes A No
seepage, etc.)
3/23/99 Continued on back

Facility Nutpber: — LADate of inspection Q Printed on: 7/21/2000
5. Are thereed any immediate threats to the integrity of any of the structures obse ? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes 'QJ 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 KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes QkNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'? ❑ Yes PNo
Waste Application
10. Are there any buffers that need maintenance/improvement'? ❑ Yes 'moo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes X40
12. Crop type LS4 ISV JU CbU`�, YU14
13. Do the receiving crops differ with those des mated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes .;Io
b) Does the facility need a wettable acre determination? ❑ Yes Eg, o
c) This facility is pended for a wettable acre determination? ❑ Yes R' o
15. Does the receiving crop need improvement? ❑ Yes Ozo
16. Is there a lack of adequate waste application equipment? ❑ Yes VNo
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
qNo
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
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
���Q...�&O
pp No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
'i No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KIo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
R No
dVd Yiolati6tis:0 deficiencies were p6ted during {his:visit: Yob :will i ebeive do further
correspondence:aboufthis vtstt ::...::...:............ .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): -
J ,I s w i ll b e, i►�51�t11 1,,,�OL4-4 A- . WOV& 14Ds4_7yM1�der_. 1�^�
(Tr\1-S ►mot S w�Y�� Pvtrr 4� 4-
1
��y, �6 }r>1[','i tti— �t0 Shot ✓ ..�i� ti. t�^ 2 ,a1Lc .
1'1 . cr%\vvlOUSi rn.
� t�+� 1�k P �v wtvt�, 5 5
Reviewer/Inspector Name V, �' C UJ R jcj 1,
ReviewerQnspector Signature: _ / alp Date:
5/00

Facility Number: —LJ I Date of Inspection
Odor Issues 91i�
`!
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [I Yes LSO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes W10
❑ Yes 'WVO
[]Yes I�NO
❑ Yes o
❑ Yes o
❑ Yes o
Ili 500a re CaV94
4 �

Division of Soil and Water Conservation -Operation Review
E3 Division of Soil and Water Conservation - Compliance Inspection
" Division of Water Quality-- Compliance Inspection - - -
E3 Other Agency- Operation Review
WRoutine Q Complaint Q Follow-up of DWQ inspection Q Follow• -up of DS%VC review Q Other 1
Facility Number a- I Date of Inspection
Time of Inspection E]= 24 hr. (hh:mm)
0 Permitted XCertified 0 Conditionally Certified ❑ Registered [3 Not Operational I Date Last Operated:
..........................
FarmName: ................................................. County: ....................:\".1...... ...................... .......... ..... ........
Owner Name:
..._..._?..._S.F............................................................ Phone No:......1..+oSS..-...L.......L.J.....................
Facility Contact:
Title:
Phone No:
MailingAddress: ..................................................................................................................... ....................................................... ..........................
Onsite Representative:.,....................................................................................- Integrator•
.........................
I..�vy�� .._..............VP...........................................
Certified Operator:
Operator Certification Number:
Latitude =•=' =-1 Longitude 0• =1 =11
Swine Capacity Population
oo
800
Finish
Wean
o Feeder
V-
o Finish
0Feeder
Number of Lagoons
Holding Ponds/Solid Traps 0
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
❑ Subsurface Drains Present ❑ Lagoon Area [[]Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated al: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the Slate
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'?
❑ Yes N(No
❑ Yes [x No
❑ Yes [ANo
❑ Yes
IX No
❑ Yes
N(No
❑ Yes
UNo
❑ Yes X No
Structure I Structure 2 Structurc 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ......... �Q.............. _.............. � .................
1/6/99 Continued on back

Facility Number: — a Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes 4 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes 10No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9.
Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
i�No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
14'No
11.
Is there evidence of over application? ❑ Ponding ❑]rNitrogen
[I Yes
CqNo
12.
Crop type �/�^..1.1��...... �._'1.f..Sj.................................................................................................................................
(....�4��!.!.ht....
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
VNo
14.
Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
t4 No
15.
Does the receiving crop need improvement?
]Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
D$No
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?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
i4No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
j No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
VNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
IXNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[�INo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
(KNo
0NO.Vlolatlon8 or. deficiencies .were noted daring A1iis'visit..1 oli wilfretieive no farther . .
:•edrrespotideitee;abbitt:this;visit,;
,,, ;,; ; ;,;,;,; ;,;,;,;,;,;,;,; ;•:•;.;.;•:•;.;.;•;•;.;.;.; :.;.;.; ;
Comments (refer to question #): Explain any YES answers arid/orrany recommendations or any other comments
Use drawings of facilifyto better explain situations. (use additional pages as necessa
� A\-.s 512", 3 �s V-e—cc
Reviewer/Inspector Name - t
Reviewer/Inspector Signature: Flo A) Q Date: t 1 -1-6 1 "l I1/6/99

Q Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
Date of Inspection I'm
Facility Number o�\`)
Time of Inspection 'a :.iQ 24 hr. (hh:mm)
0 Registered ti Certified 0 Applied for Permit E3 Permitted JE3 Not Operational Date Last Operated; ,,,,,,,,,,,,,,,,,,,,,,,,,,
FarmName: ..... 1JI \/�—?!�\ ] --c � ... � `..................................................... County:..�..]...q..1......................................................
Owner Name:....... F\.' \...t 2 5..................................................... Phone No:..1.�..\. `�Sr�I SN S
Facility Contact:
Mailing Address: , bk.
Title:
OnsiteRepresentative:.!;:� ..........................................................................
Certified Operator: ..................................................
Location of FarmL t
..................................... Phone No:..................................................,
..v Ne:..._1��......�...((.. j�.�.5......................................
Integrator: ... kS.SaT�`-.................. _..........................
Operator Certification Number :.........................................
Latitude =0=1=11 Longitude =•='="
Design Current: -:'Design
'Current :: 'Design Current"•
Capacity,Population,, Poultry. "Capacity
Population Cattle Capacity Population.
`= Wean to Feeder 6L(00 I0 Layer
,: ❑ Dairy
"
. ❑ Feeder to Finish m- ❑ Non -Layer I
1 10 Non -Dairy
_- ❑ Farrow to Wean-
❑ Farrow to Feeder ❑ Other
-
El Farrow to Finish
Total Design Capacity
v ❑ Gilts m,
Total SSLW ,
❑Boars_
Number of Lagoons / Holding Ponds 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
- £ a ❑ No Liquid Waste Management Systems > H:
^.
_
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 14 No
2. Is any discharge observed from any part of the operation? ❑ Yes IN No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes t No
c. If discharge is observed, what is the estimated flow in gallmin? t iA
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes 1J No
3. Is there evidence of past discharge from any pan of the operation? ❑ Yes [4 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 14 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ZNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes MNo
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes fXNo
Structures (Laeoons.11olding Ponds. Flush Pits, etc.) ,
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: A-
Freeboard(ft):........ �r�...,..5........................................................................................................
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 Auolication
❑ Yes
ONo
Structure 5 Structure 6
...............................................................
......................................................,...�......{........
[I Yes
J? No
❑ Yes
C9 No
0 Yes
❑ No
❑ Yes tit No
14. Is there physical evidence of over application? _ ❑ Yes D9 No
(If in excess of`WMP, or runoff entering waters of the State, notify DWQ) I
ls. Crop type . ...... _`�..�.1.... ..............�:� 1 wf41. w��� S� ............................................................................................
.............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes '0 No
17.
Does the facility have a lack of adequate acreage for land application?
0 Yes
W'No
18.
Does the receiving crop need improvement?
Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
a❑d
to No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
OrNo
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EffNo
22.
Does record keeping need improvement?
❑ Yes
gNo
For Certified or Permitted Facilities Ont
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
MNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
D4 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
P No
0-No.violAoi
nsor deficiencies.were noted dt .ritig this;visit. YodMH receive nti ftirther
correspkideuce about this:visit::
l.l)
IFi
Noss`\�jt?.
7/25/97
�,-
Reviewer/Inspector Name IBM
)<
Reviewer/Inspector Signature: ��� O Dater 023

gY' ❑ DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection z
Ira Routine V Complaint V Follon,-up of DW'Q inspection 0 Follow-up of DSWC review p Other 1
Facility Number
Date of Inspection 9 y
Time of Inspection J1: 24 hr. (hh:mm)
13 Registered 10 Certified l] Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated:
FartsName: .......... b!!xvn-arA......... J......vawh................................................................ County: ....... bi.{Ilr.......................................
Owner Name: ..........N�/DY%...... 14A:.... Ints.......................................................... Phone No: lftl ...4 0....-A3 is. ...........................................
Facility Contact: .......j!,,ts.] ! . prtaS...^...`.............................. Title: ......... 0.0.1�....................................... Phone No:.4t`.!1.r7.i.45&gT.q.5-...........
Mailing Address: ...... (Q i....... ....i..rsUf ...n..1.:............................................ ..........!if......ittCr...iJttL..................................... .436.�.......
Onsite Representative: ......... ��.+-r.................. �Q&&-............................ ............... integrator: ... per. .
Certified Operator, ........... 0al.6-N......... L,......
Location of Farm:
Operator Certification Number:.._UP371 UP371 ...................
Latitude 0• ©' �" Longitude 0• �-! ' ©4,
Swine - Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Poultry Capacity Population Cattle - Capacity,. Population
❑ Layer 1 ❑ Dairy
❑ Non -Layer I ❑ Non -Dairy
❑ Other
Total Design Capacity I 6.goo
❑ Boars Total SSLW I (qy, goo
Number of Lagoons Holding Ponds 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ 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 convevance 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 gaVmin?
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?
❑ Yes ® No
❑ Yes ® No
❑ Yes 159 No
❑ Yes [A No
❑ Yes No
❑ Yes No
❑ Yes q No
❑ Yes IV No
Continued on back
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97

F_q_,.jgty.1Sumber } —LI
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
Da No
Structures (La2oons.11oldin2 Ponds, Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
ja No
' Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: 1 ...........*?..Z.....................................................................................
Freeboard(ft):........... 1'3................. ............ L 01 ................ ................................... .................................... ....................................
....................................
10.
Is seepage observed from any of the structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
0 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
P9 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
X) No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
f l
Crop type ............ 6-rftv�9_ 1116..... .............. ................ ..................................1.............................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
tRYes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
21.
Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑ Yes
W No
22.
Does record keeping need improvement?
[P 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
CO No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
No violations or deficiencies were noted during this.visit..You .will receive no further
correspondence ahou( this visit.
to question #): Explain any
any
or
i�. spy s PItL,,W in AfIds _&X - Aot If-_Q in C'r_•�_4(3 pf&.. seyb(4a„5 ShOdd b: Add&) v -
la= Cooslnl I'sexmu& C-Op S64 toe i4xPybL4.
zz• "Ue�s S(W'Q toe. ( ke ley -Z&L, outrtoer a.nt] WJAvm6r qJ (L�(awtn5 �
Z'6kA S6013 loe. V\ cervi�c� �i tb
PJan. U�d"' a_j analysis S64o be Iv\ Tfar1:
Labe ttv �h WaSt� Wr^S �UmPec� tr6n. i nr / yeCOrflg, jJ, ppeYN+iSSrbn
FAIVY- +kOLK Z's, 4, -56')0 loe. txx ej . lah. IY-r�j'ton CV-' nW 'k
eC1 �t cG �i-orts �e
7/25/97
Reviewer/Inspector Name
IReviewer/Inspector Signature: (4 / <nh, Date:

Site Requires Immediate Attention: q
Facility No. 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ' -1 1995
Time:
Farm
Address:
County:
Integrator.
On Site Representative: A
Physical Address/Location:
Type of Operation: Swine v Poultry _ Cattle
4 ul-v
Phone:
Phone: 6 — e6.20
Gti1,"
Design Capacity: 6 y0 O Number of Animals on Site: 61/0 O
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3_5 ° (7?' Longitude:'_` 3-' 19 Elevation:Feet
345 D 7 t. ;_7 Circle7�e?orN, 7 3�1
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot +,25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (e or No Actual Freeboard: Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes of 1�5 Was any erosiserved? Yes or(g
Is adequate land available for spray? Cam" or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS
setback criteria? 200 Feet from Dwellings? 0or No
100 Feet from Wells? a or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ord!
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or 70
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or ® If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? �r No
Additional Comments:7_d'_F?cti1 —
Insp ctor Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.