310247_INSPECTIONS_20171231

i -IdM
NORTH CAROLINA
Department of Environmental Qual

Cype of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: ErRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: FZFT----1 Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Z (Pp((8-
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
'X- -j OR
Design Current
I) ,+ P,oult , Ca aci P.o .
Layers
Non -Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
01 Boars
Pullets
Beef Brood Cow
Other
01 Other
—TurkeyPuults
Turkeys
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
&No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: 71Z Date of Inspection: Cc
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-'L-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental 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
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 Q N ❑ 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? r
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):
f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L_Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�_eNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ 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: 11
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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes No ❑ NA ❑ NE
Page 2 of 21412015 Continued

Facilitj Number: '; ` - W Date of Inspection: 17
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E;,W6�aNA
❑ 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
Io —❑ 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
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
Q-IQo ❑ 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
DA_0_�E] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EyNo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA
rNo�
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes❑
NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.:... u, I Use drawings of facility to better explain situations (use additional pages as necessary). '
O. k e C.� cC erof., r.
Cow f . V% A-C,
kc, Pk
ot\ Sa rC 0n'
Reviewer/Inspector Name:
Reviewer/Inspector Signatuc
Page 3 of 3
Phone: 2(071G ��nl
Date: 6 1
2/4/2015

Type of Visit: (b Co pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: , )IL, ) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: (3 "NT I YLjLjj 6U , Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
11-ayer
Design
Capacity
IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I
JNon-Layer
I IDai
Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . W $oplt .
Layers
Design
Ca aci[
Current
PaoP.Non-Dai
Dai Heifer
D Cow
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
jBeef Brood Cow
Other —TurkeyPouets
01 Other
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes zl�o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes jJ1 o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Ins ection:
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 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
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?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 21"No ❑ NA ❑ NE
❑ Yes {fNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en ronmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E3<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P['Nlo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes tj No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysi
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V
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?
❑ Yes [7fNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ ❑ Yesg�No, NA ❑ NE
❑ YesNo ❑ NA ❑ NE
❑ YesgEI
No ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Other:
❑ Yes
Jo
El NA El NE
s ❑ Waste Transfers
❑ Weather Code
Rainfall Inspections
❑ Sludge Survey
❑ Yes
�fo'
❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: f7 I Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ElYes 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 E_, "o �❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Lam° ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Dleo ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑ Yes
NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
Jo
❑ NA
❑ NE
❑ Yes
L_I Nc
❑ NA
❑ NE
❑ Yes
Z1 "o
❑ 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). = 4
7,) Oskb W jqU, PEG 05 u rIZ,T AN b 61"YS- 06 0-k-
t c e'656 avpfl-G-5�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

(Type of Visit: 0 Co pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit
?Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t��/ q / Arrival Time:z= Departure Time: County: X Ql lA Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: 09_eNt f k,,cHaL-
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: (P
Certification Number:
Longitude:
C•unrent
Capacity Pop.
to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
to Feeder
Non -La er
Dai Calf
r to Finish
Dai Heifer
lDesign
w to Wean
w to Feeder
to Finish
1) , P�oultr.
La ers
Dign
Ca tacit
Current
P,o ,
D Cow
Non-Dairyw
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
e
El Other
Turke
TurkeyPoults
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 D W R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DW R)
2. Is there evidence of a past discharge from 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 0NNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑Yes ❑N ❑NA ❑NE
❑ Yes ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

�kVFacili •Number: - Date of Inspection:
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
Identifier: L ./
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):---�--4--
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme,,,n{{{t//t I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes (/ I j)t'o ❑ NA [3 NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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 CAW MP?
❑ Y s
Ea'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yees
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ZNo
❑ 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
Noo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
2/yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Io
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2 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 Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EK9' ❑ 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:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes IdJ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes - No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA _ ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 2Ko ❑ 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ILJ 110 ❑ NA El NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
[] N ❑ NA ❑ NE
❑ NA ❑ NE
g'No ❑ NA ❑ NE
ICommerits (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
lice drawinns:of facilitvtn'hetter exulain situations (use additional naves as<necessarv).
1 5) LZMro d 66D0
0 C STri TES
Svpe6sc-o To
Reviewer/Inspector Name:
Reviewer/Inspector Signanu
Page 3 of 3
keq Cd 19t/
ISoo feG0e'R
►3 r. e710 .
6F T� UkF�
WILL, NAV(—
mU,ED fit j6S�T
cAK/r) I(- CT E D,
Phone: (-f ), u) Iq t7
Date:
5

Reason for Visit: (d Routine U Complaint p Follow-up 0 Referral O Emergency O Other, �C) Denied Access
�UP Date of Visit: Arrival Time: ® Departure Time: (� County: UIA) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 3 Q_C-.or- MT Tcih.0 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 2 6 -0 *
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
D ,+P,ouI .+
Layers
Design
Ca aci +
Current
P,o
D Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EkNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes fJ Np ❑ NA ❑ NE
[:]Yes VNo ❑ NA ❑ NE
Page I of 21412011 Continued

FAcility Number: Date of Ins ection:
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
Identifier: LA&UDA)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 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 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 [J o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ Ndt ❑ 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 [.Q "" ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑-Qo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ago ❑ 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[✓ -Ves
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[:kN6
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Er<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q-1qu­
❑ 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
D 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
❑.N6-
❑ 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
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

FAcility Number: Date of Inspection,
No
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
❑ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
4114 ❑ 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
ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
L!d"R'o ❑ 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
Flo ❑ 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
[g-?do'
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E31 o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[],No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E3 11To
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
fJ Ko
❑ 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).
15,1 L��WLE ►,1EL0�f
Reviewer/Inspector Name:
Reviewer/Inspector Signature,
Page 3 of 3
Date:
IJ

Reason for Visit: (2f Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: [ .44jrS 1 Arrival Time: Departure Time: Z,( County: T)L)P Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: (3 i tft ' , t-+. j C44 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
db
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,o_ul
ILayers
Design
Ca aci
I
Current
P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
El Other
I
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes &No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes L9 ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility N mber: I - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 No
a. If yes, is waste level into the structural freeboard? ❑ Yes [-]No
Sttructure'1 Structure 2
Identifier: �A%N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑NA ❑NE
DNA ❑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 ]dNO ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 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 Yo ❑ 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 No ❑ 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 CZNNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes j—j(DIo
❑ 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 /Nc
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ 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 ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JGI NO ❑ NA ❑ NE
Page 2 of 21412011 Continued

Facility Number: 'g Date of Inspection: S
24. -Did the facility fail to calibrate waste application equipment as required by the permit? t
❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
5/❑NA ❑NE
No ❑ NA ❑ NE
© No
EZ /No
� Z/No
21/No
U No
E- `
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[Comments (refer to question #): Explain any YES answers and/or, any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
►7

Type of Visit: Q'Cooptpliance Inspection O Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: lqv Z Arrival Timer Departure Time: /© County: L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: G9_f xr-I- MS-r C&E Ll— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
-u'648
Swine
Wean to Finish
Design Current
Capacity Pop.111p
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
JV
Feeder to Finish
Farrow to Wean
0
Dry Pooutt .
Layers
Design
C•_a aci_
Current
P,o ,
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
I
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [/NNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ o ❑ NA ❑ NE
❑ Yes VNo
❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
Page 1 of 21412011 Continued
F

Facility Number: Date of Ins ection: %L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
lo
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: L4 &-y�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes �/*
❑ NA
❑ NE
maintenance or improvement?
7No
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?
0es 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 BNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Noo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
—
❑ Yes I I,NO
'�Y
❑ 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes 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 21412011 Continued

Facility Number: -3 jDate of Inspection: ✓
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes E No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes &o ❑ NA ❑ NE
s
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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes �o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question f: 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).
/S;> c rn�E Vf6EDEt7, IG`,69 Co�'� o{ �'cKF% � /�Eco,eDf
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: (TIP) /%G-737
Date: 01L
Page 3 of 3 1 21412011

Type of Visit: (0 Co fiance Inspection V Operation Review Q) Structure Evaluation Q) Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Q Arrival Time: ® Departure Time: "3u County: ©L4:7 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: B (?_,Jt (Y TC+4&L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity P.op.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P�oulh.
La ers
Design
Ga aci r
Current
Po ,
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
I - her=
Other IOther
Turke s
Turkey Poults
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
do
❑ NA
❑ NE
Page 1 of 21412011 Continued

Facifity Number: Date of Inspection: V lb ly
Waste Collection & Treatment ,{ _
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes Mo
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
1
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes CZ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ey<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Ej No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes tj No
❑ 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 2<0
❑ 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
El Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [3/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
—
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes 9 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ILJ 1Ve ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faci6 Number: 24% jDate of Inspection: /Dit
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 g No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0410 ❑ 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 �Io ❑ 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
Ef 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
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
/ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations orany other comments �
Use drawings of facilitvto better exolain situations (use additional Dages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:

Drvtsion of Water Quality
Facility Number, i�Y7 'vt .Q-Diston of Sod and Water Conservation
QOtherAgency
erj
Type of Visit Corppliance 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: F 3 7n /b Arrival Time: D-3-07 Departure Time: O County: PVRZA) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: da.cy mA4,4(1i Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = = « Longitude: = o Q ,
' Design CurrentDesign
Current DesignsCurrent
Swume Capacity Population;--=` Wet Poultry Ca city tolls thon the Capacity Population
_.
❑
Wean to Finish
❑ Layer
❑ Dairy Cow
❑
Wean to Feeder
". ❑Non -Layer
El Dairy Calf
+
Feeder to Finish
b
-.:=,� ,�r.
" �,, ❑ Dairy Heifer
�'
- . ,�,
��..,Dry„Poultry„,
El Dry Cow
❑
Farrow to Wean+-,.
❑
Farrow to Feeder
""""'
�" ❑ Non -Dairy
.„
❑
Farrow to Finish
❑ Layers
❑ Beef Stocker
k.;
❑Gills
' ❑ Non -La ers
3 ❑ Beef Feeder
4
❑
Boars
Pullets
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
I ,, ❑Other
4 .
NumbeofStructures:
,_F„
Other
......
,:
❑
Other I I
Discharges & Stream Impacts
�
1. Is any discharge observed from any part of the operation?
El Yes
2 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)?
0
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,❑,
�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page i of 3
12128104
Continued

Facility Number: — Date of Inspection
tLWaste 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: t.P-T—
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 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E3 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 environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes WNo
o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �/
9. Does any part of the waste management system other than the waste structures require El♦/
Yes J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [7No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ld No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 97No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 12 ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
.Comments (refer, to question #) 'Explain any YES answers and/or any recommendations or any other comments �"�
.Use.drawrngs:of facili 4o better en ty
.explain situations (use additioal"pages as necessary) ' <
Reviewer/Ins ector Name °" �''"''"_•'` Phone• . P pl is G
Reviewer/Inspector Signature: Date:
'age 2 of 3 12128104 Continued

•[Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,E No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections [I Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1�9 C ❑ NA [I NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P] No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �I oo ❑ NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes EINo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ZNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes'Ej
EjNo ❑ NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes LJ No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately ,..,I (/
31. Did the facility fail to notify the regional office of emergency situations as required by El Yes I� 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 <1NI El NA El NE
33. Does facility require a follow-up visit by same agency? ❑ Yes d No ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Coptpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0_/Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of visit: It G Arrival Time: ® Departure Time: County: _ ti PfttU Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: 90-6w - t�AbYtd 6ld Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=oF—T [= 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 U No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No,
❑ NA
❑ NE
NA
[I NE
❑ Yes
No❑
❑ Yes
,❑, to
❑ NA
❑ NE
❑ Yes
L No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 'j — y Date of Inspection I u
VV_aste Collection & Treatment
4' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
_ //
Id No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L9 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
�1J No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E,1,1�o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
,.,//
I� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(3'No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
C1 o
[I NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
WJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
21'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
6
❑ NA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
No
❑ NA
❑ NE
@ommepts (refer to queshopl#) Esplamyapy_YES answers and/or any recommendations or any other comments
Use drawmgs.of facility"�to�better explain+sttugtrons. (usetadditionatyages as,neeessary,):
L-CMX NLe6DAd eN ALC- J'0 L SAmAL;(s a Ar 6MJ_1' /t+n/
Reviewer/inspector Name o L Phone: — %
Reviewer/Inspector Signature: C16<1 Date: 14
Page 2 of 3 12128104 . Continued

IFacility Number: —ay Date of Inspection 21
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage &Permit readily available? El Yes EN ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes Lr /No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2 No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
P Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections
❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z////��JJJJEl NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
L� yo ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1 ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
o ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4�
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
1
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
L No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,,��,,//
[2 o
❑ 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
�--��
4,`0
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

3
(Type of Visit 0Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Q/Routine Q Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: D o Arrival Time: ® Departure Time: County: /ifA�ec'r Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: 894-A)t r�Lluw Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: r-7 o[7, M Longitude: n° n n
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Populafion
Cattle C+apacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
JLJ Non -Layer
I I
I ❑ Dairy Calf
Feeder to Finish Z7810
fls
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
El Non -Layers
Beef Feeder
❑ Boars
ElPullets
El
ElTurkeys
❑ Beef Brood Col i
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 2No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
El No El NA
[I NE
El Yes
❑ Yes
ICa<oo ❑ NA
❑ NE
❑ Yes
l o ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number:
Date of Inspection o Q
Waste -Collection & Treatment (
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier: LA (rid
❑ Yes lNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ETNo
(ie/ large trees, severe erosion, seepage, etc.) (/
6. Are there structures on -site which are not properly addressed and/or managed ElYes 21 No
through a waste management or closure plan?
Structure 6
El NA El NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes El"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ENo ❑ 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 Elif Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,_,//
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes l� No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
ElYes
E3<oo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Q K*o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
C3 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):
'ZO SCmp �°/'r <� zor ate T pwd . -
Reviewer/Inspector Name Q�% (�(� Phone: —7
Reviewer/Inspector Signature: Date: 6 log
12128104 Continued

Facility Number: — Date of Inspection L
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 El Other
❑ Yes
o
[:3NA
❑ NE
ElYes
No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L✓I No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dtj 0
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
,_
L/J No
[I NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
,❑/Yes
IJ Yes
El No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes R<o ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El"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
ONo
❑ 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
Id"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
IGN0
NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Io
El NA
❑ NE
Additional Comments and/or Drawings: - '� " " " ''- -'•"�
Page 3 of 3 12128104

Facility Number 3 a
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (7Co 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: S Iy v Arrival Time: 0 Departure Time: County: 49 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: 842J--_1J1r WT L y 6L- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Swine
to Finish
to Feeder
- to Finish
to Wean
to Feeder
to Finish
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
=1 Longitude: [� ° [� ' M
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current `I
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)
1 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 O'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
12128104 Continued

•i Facility Number: ?� — d Date of Inspection S 6
i 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?
^^Structurg 1 Structure 2 Structure 3 Structure 4
Identifier: S_!'1(tSA�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes R No ❑ NA ❑ NE
❑ Yes UNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes/Nc�
❑NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes N j❑ 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
El NA
❑ NE
Z' ❑ NA
ElNE
50Noy�[INA
❑ NE
El NA
El 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 J _v f) r✓ f A 2l✓IeLU Phone ( %3 I
Reviewer/Inspector Signature: /�, Date: S Iy (n7
12128104 Continued

w/m
I Facility Number: _� I —Off/ I Date of Inspection
Required
Records & Documents
/
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
i.,J[ No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2 No
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
LJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Pico
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
01Np
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
t�l�
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LJ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ff-No
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
L No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
L3No
❑ 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
Id N
0❑
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
NA
❑ NE
Comments and/or
12128104

dDivision of Water Quality
weiilty Number 3 / �.� O Division of Soil and. Water Conservation
- - - - - O Other Agency
(Type of Visit (n Corppliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: ,3 OG Arrival Time: ® Departure Time: County: 0140tlld Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title:
Onsite Representative: i9AAi 62A V Il Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Ottier
In Other
Latitude:
;ign 'Current'
acitp'Population `. Wet Poultry'
Dry Poultry
Phone No:
Operator Certification Number:
Back-up Certification Number:
FLongitude:
n - Current.
ity, Population Cattle'
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
ax�M�c
❑ Dairy Cow
❑ Dairy Calf
I
❑ Dairy Heifer
-
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
'Number of Sfructurf
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 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes I lb ❑ NA ❑ NE
❑ NA ❑ NE
12128104 Continued

Facility Number: 3 i —Z ') Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: L-A froaAJ 1
Spillway?:
Designed Freeboard (in):
C
Observed Freeboard (in):
4 Z+
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 u No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �EN4 ❑ NA ❑ NE
El Yes E7 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentallthhrfat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ld N El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E/o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E14 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ 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. Croptype(s) C4 CLJs
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
❑o El NA El NE
�J1 ❑ NA ElNE
V[J o El NA El NE
❑NA ❑NE
EINo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
,FA941, XIJb r(-&(02t7s Co°'c- 606P !
Reviewer/Inspector Name I _�4rj
��/A "� ( � Phone: '11t? `16 - 7A
^^
Reviewer/Inspector Signature: c Lr1'r... Date: 3 % y(o 1f(,
12a8104 Continued

Facility Number: 3 — Date of Inspection
l/
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Elk ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)Vo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspection�No
Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LiiJlio ❑ NA ❑ 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? ❑ Yes ,�JN/_O� ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes Ld No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,,._ <( [I NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes l(J 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 Ej No NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes o ❑ 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, [I NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes lra-�i oo ❑ NA ❑ NE
Comments and/or
Page 3 of 12128104

IType of Visit 51 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: fT Arrival Time: I Departure Time: County:
Farm Name: /� Owner Email:
Owner Name: l! Phone: _
Mailing Address:
Physical Address:
Facility Contact: ,fQJ,� Title:
Onsite Representative: "L ")T
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
/y Phone No:
(� Integrator: azt5 zw0
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [o =' = Longitude: =o=.
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: LF—i
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 ILI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A,No
❑ NA
❑ NE
El Yes JCJ No ❑ NA ❑ NE
12128104 Continued

✓1
Facility Number:— Date of Inspection
Waste Collection & Treatment ���fff
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /Q No El NA ❑ NE
a. If yes, is waste level into the structural freeboard? [IYes /❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A/
Spillway?: A10_
Designed Freeboard (in):
Observed Freeboard (in): i 170
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes /PlNo ❑ 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 y� No ❑ NA ❑ NE
8. Do any of the stucmres lack adequate markers as required by the permit? ❑ Yes 1(3 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 El Yes ILJ No ❑ NA El NE
maintenance/improvement? <,_,(
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VJ 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 Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 10 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes VNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes ffNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes /ICI No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑Yes lyNo ❑ NA ❑ NE
/5) s D7A4 /e57- K PD�� �h`a�•s,o Irw z � •�nr-siu
T-rS A0, zvw' ,&ce__r�s
z)� 5 �fRRFNO ��4-2 Fe *oP
Reviewer/Inspector Name j Y'- Phone:p—
Reviewer/Inspector Signature: Date: V�4

Facility Number: — Date of Inspection DS'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ICI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes /� No ElNA ❑ NE
the appropirate box. ElWUP El Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
9Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V,,,{{{ No
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,l/_J./No
/L<) No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
/❑ No
❑ NA
/NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
36.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
FiNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
'
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
ElNA
ElNE
General Permit? (i / discharge, freeboard problems, over application)
10
,
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El
XNo
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O/No
❑ NA
❑ NE
Additi6nal Comments and/or Drawings:
4/9 ��✓ CF/FL �STZirlh'TO, ��uoCF ��v9�d�p ��/
29 �FFP �P �27ff �pmrn6eczH� �fiL� /�,ol�r��.
12128104
f

(Type of Visit fjf Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit .0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted E3 Certified 0 Conditionally Certified 0 Registered
Farm Name: .....L'%f'QQ. �e ....... fz.#!�.... A ..._..iR/Y%...............
OwnerName: ........ l._ a ...... t ll{.09p/......._..........__.._......._..................._._.....
l O Tune:
Q Not Operational Q Below Threshold
Date Last Operate or Above Threshold:............
County: .... J�i/LZi✓ ...... ........ .._._
Phone No:
Mailing Address: ........ _._................ .............
� _.___.___.__._..._--------._._ __.._._._._.__..._.__..........._......._._................_._.......__.-------------
FacilityContact: .... _.... .... _............................ _......._...._......._... Title: .._...— ....... — ................. Phone No: _.___.___._..._.._..._---__.....
Onsite Representative: A -- /..!�VT�i'/f— - Integrator: 4�V..F �.QfJ
Certified
Location of Farm:
Operator Certification Number.._.__---....___....-•--.-._.
Swine []Poultry []Cattle ❑ Horse Latitude • �° �'°
Longitude =• =' =11
Swine
Design Current.,' Dcvgo Current - •=- Design Ciuzent ^_
-Ca aci ..Po datiort` Poultry'., _ Ca`aci -Population =Cattle Ca Baia Po ulauon y i
i` ❑ Wean to Feeder
❑Layer
Dairy =
Feeder to Finish
2B80 Non -Layer
' ❑ Non -Dairy
❑ Farrow to Wean
-- -
Farrow to Feeder
❑Other
_.
-0 Farrow to Finish
T`
otal Design Capacity
❑ Gilts
❑Boars
t
Total SSLW'
o. r,.s
r Number of La gooas
r'
li - HoldmQ Ponds /Solid
Trans='
�- -'"
Discbaraes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Y" No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes /No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............. —_........... _.. ................ .... -.-- ... ... ......... ..... -......... _................... _._..._...
Freeboard (inches): I'to
12112103 Continued

acility Number: -- Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, . ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes O No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 9 No
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes &NO
elevation markings?
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes RrNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes RrNo
❑ Excessive Ponddi/iffng [I PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type e. , &/a S�,
13. Do the receiving crop(s differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
23)
❑ Yes A No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes 0 No
[]Yes JgNo
❑ Yes A No
❑ Yes Po
❑ Yes 0No
Field Copy ❑ Final Notes
a/J4-red Low A2EfF5 1a+ ���
%OND7'.✓G, ILI,, tc,4,, 1Ve60:1 7c Z6�r•�
ARnq 1�"&v :;. , �Fzr ro n G.9 �✓a f� vac �Nc- Fzt�-
vJ Aig5._
pi) QNE r�F_l./J C�
f p �zG
.SAmv�s litnf,-�
Reviewer/Inspector Name J
Reviewer/Inspector Signature:
CRC
SAmpc65 VAe-F /JF,Ep 0ovA-5
A!506c,94.sE Pe- SAT
Date:
12112103 Continued

-1
' -I Facility Number: —3#71 Date of Inspection
Required Records & Document~
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes .f No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ )AUP, checklists, design, maps, etc.)
❑ Yes ,OWo
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes )ErNo
❑ 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 j2Wo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes O�go
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes go
(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 A2T4o
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ,� No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
�0 Yes ❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes j214o
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes B' 4o
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes ,2r&
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes M-go
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes' JMo
❑ Stocking Form []Crop Yield Form []Rainfall []Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

of Visit 30 Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit P Routine O Complaint O Follow up O Emergency Notification O Other
Facilitv Number
13 Permitted [3�C,ertrtified [3 Conditionally Certified Q Registered
Farm Name: ....L :...=7 ._�
Owner Name: ...............tFl:r .----- .. R'.[Y_............_........—_......_........_...
MailingAddress: ............ __................. - ... _..................................
Facility Contact: ......... ... ........... _........... __......_ .. Title .._._..... ...........
Onsite Representative: ,„�JtQ .-!.._.l.......G�Cl�fLG
...................................
Certified Operator.
Location of Farm:
❑ Denied Access
Threshold
Date Last Operate or Above Threshold: ..
County: ..._..................................................���
Phone No:
................................ .P1�hone No: ................. _................................
Integrator* ....,C%Tl.�r.iQQ................................_..
Operator Certification Number:.-,,,, -__-_-
/Swine []Poultry ❑ Cattle ❑ Horse Latitude �° �` 1_l" Longitude
Discharnes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Yes (�No
Discharge originated at: ❑ Lagoon ❑ Spray Field [] Other /
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes []No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes /'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment _ /
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes /No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .........�!................

Facility Number. l — Date of Inspection .
5. Are there any immediate threats to the integrity of any of the structures observed? T(ie/�trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenanceimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelrnprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelmprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type ( �0,enl G✓h64-r )04f eAA) 5
13. Do the receiving cropidiffer with thds designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
❑ Yes (7{ No
❑ Yes // No
❑ Yes t71 No
❑ Yes /No
❑ Yes X,o
X
❑ Yes No
❑ Yes �j No
Waste Management Plan (CAWMP)? ❑ Yes Vr,No
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18.. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlntspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? .
❑ Yes No
❑ Yes [ No
❑ Yes No
❑ Yes No
❑ Yes //(�No
❑ Yes [�No
❑ Yes No
❑ Yes Q�No
❑ Yes [�No
❑ Yes /XNo
❑ Yes f�No
❑ Yes l[No
❑ Yes�No
[IYes (21No
' p No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
❑ Final Notes
�/Js �✓ Oox-
Reviewer/Inspector Name
Reviewer/Inspector Signature: _�4i All Date:

,17 Facility Number: Z-77� 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
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 ENO
❑ Yes o
❑ Yes No
❑ Yes X No
❑ Yes I/1 No
❑ Yes No
El Yes I[J No
Additional Comments and/or Drawings: . ;,.,, .,,,�..„u x "' �,�,. •; -.. .. -: .;-y �......,, -
O5103101
O5103101

Plan'Amendment to Include S&WCC Chronic Rainfall Practices and Standards through March 31, 2000
L If this facility can comply with its existing permit and CAWMP it must do so.
2. Temporary Addition of New-Sprayftelds{'}(Check appropriate boxes.) - - --
fJ A. _ _acres of cropland. List crop types used:
Q B. acres of hardwood woodland Q 100 lbs PAN / acre added.
Q C. acres of pine woodland added Q 60 lbs PAN / acre added.
3. Supmer Perennial Grass (Check appropriate box.)
Q A: Application window extended for - acres of perennial grass until first killing frost.
Q B. An additional 50 Ibs of PAN applied to acres of perennial grass prior to killing frost.
4. PAN Application Increased for Small Grains & Winter Grasses to be harvested. (Check appropriate box.)
A. PAN application increased up to 2001bs per acre for !;'�,_ acres of small grains or winter grasses to be harvested.
B. PAN application increased up to 150 Ibs per acre for _ acres of overseeded summer perennial included in 3. B.
5. Waste Analysis (Check appropriate box.)
0 A. Prior to December 1°,-1999 the calculation of PAN will be based on a 35% reduction of the last analysis taken
prior to the first 25 year 24 hour storm event (Current waste analysis must be used after Dec. I' .)
$B. Use current waste analysis to determine PAN.
6. Required -Maximum Nitrogen Utilization Measures for Small Grains and Winter Grasses.
A. Use of higher seeding rates,
B. Timely harvest of forage to increase yield, and
C. Irrigating during periods of warmer weather.
7. Required - Irrigation Management Techniques to Reduce Runoff and Ponding Potential.
A. Making frequent, light irrigation applications, and
B. Not irrigating immediately before predicted rainfall.
S. The owner / manager is required to manage the movement of animals to and from the facility to minimize environmental
impacts, ensure compliance with the facility's permit and amended CAWMP, and avoid discharge to surface waters.
9. Authorization to use the additional practices included in this amendment expires if a facility discharges to surface waters.
Any discharge is a violation and may result in an enforcement action.
10. The owner / operator is required to keep records of all waste applications.
11. This revision must include a map or sketch of new land application areas.
Facility Number 3 1- 2 4 7
Owner / Mapager Name (PRINT)
Dated E
Facility Name
6VOftoo 1, PErms
Technical Specialist Name (PRINT)
c "cal Specialist Signature
Date Z6 wy q q
This document must be filed at the SWCD office and be attached to the facilities CAWMP
and be available for inspection at the facility.
(') New temporary sprayfields must meet applicable buffer and setback requirements. Waste must not be applied to wetlands.
11/11/1999

Type of Visit % Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit P Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number d Date or visit:
)�Perntitted Q Certified 0 Conditionally Certified E3 Registered
Farm Name:....... _U.... -.1Z........^FL-► i..................................
Owner Name: .....lIj,...........................
FacilityContact: ...............................................................................- ale:..........................
Date Last Operatcl Or Above Threshold:..
County: .............._!�DI �..........................
Phone No:
Phone No:
MailingAddress: ............... . .....................................................................................
............................... . ..........I.._.,, P,, f 1`
Onsite Representative:....._!.........._....1_T...laf'SLk..L........................ Integrator...........R.tW..S. r�.�........l.l.\..1.�`..1.......
Certified Operator: .................................................. ........................................................... ... Operator Certification Number:.......................................
Location of Farm:
❑ Poultry ❑ Cattle ❑ Horse Latitude =• =1 =«
Longitude =• =' =11
Design - Current - Design Current -. Design Current
Swine 'Capacity- Population Poultry- Capacity aci Populationp Cattle Ca aci ty Population
- ❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish l gi(Ti ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean - -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Cagacity
❑ Gilts
❑ Boars =Total SSLW:'':i
- Number of Lagoons �r , ` ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdt :Ponds / Soltd Tra s1 0 i ❑
.a8. p No Liquid Waste Management System ._
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
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?
I Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
01/01/01
[]Yes Q{J No
❑ Yes '❑ No
❑ Yes ❑ No
-.vA-
❑ Yes ,,,,,,..❑ No
pd ❑ Yes No
[]Yes )Q I No
Continued

Facility Number: — N Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
It
Freeboard(inches22.........................................................................._..........................................................................................................._........
) ............3.................................................................................................................................................................................................
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
I�No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure
❑ Yes
�No
plan?
([f 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
,,,,........,,//{{
40
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
jo No
11.
Is a idence/gI over appp ation? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
&NO
12.
Pere
Crop t 1 1 I
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes
17. Are rock outcrops present?
18. Is there a water supply well within 250 feet of the sprayfield boundary?
�on-site ❑ Off -site _
Required Records &Documents '' ``
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ Unknown Yes
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 attor below
liquid level of lagoon or storage pond with no agitation?
❑ Yes 1No
❑ Yes *o
❑ Yes No
❑ Yes No
❑ Yes li�o
❑ Yes No
❑ Yes No
❑ Yes qNo
❑ Yes O(No
❑ Yes ONo
29. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes O.No
01/01/01 Continued

Facility Number: — Date of Inspection
30. Is there any evidence of wind drift during land application? (i.. re due 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 permanentllemporary cover?
Printed on: 1/4/2001
❑ Yes $�No
❑ Yes 6fl No
❑ Yes XNo
❑ Yes KNo
❑ Yes O.No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) - Explain any YES answer andlor any recommendations or any othei comme_nts�'��'— ��' �'
Usedrawtngs of facthty to better explam sttuadons (u'�se ad_dthonal pages�as necessary) �r `"�'a�""Y` � � � �
.� ; �. .,�, �, � - r -�dr -=--� � ❑Field Copy ❑Final Notes �. ��
.=...a t�+a i..z=F. s?_ _..... .-,�. .,xis.._. "^;�.�-�" �..�-cS'�.,.- .a7-�,t-,+_+-�� ��� _�J��•':
I'l�Gv�'� I �rz + � i ►u.P h' "-`.'t_- ��D 47� . w lA� f Yc-y►� cGt, �-
D
�L f�, _ _
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
r —
01/01/01

Facility Number /j,\ — 9 1�7 Lagoon Number ... t......... Lagoon Identifier ...A) .... r.kb....... (_iY►? -
`Active 0Inactive
35. Surface Area (acres):
36. Embankment Height (feet):
37. Distance to Stream:
Latitude 35 ®® Longitude © 4
By GPS or Map? GPS ❑ Map GPS file number:
L ►b rtx
O less than 300 ft O 300 ft - 1000 ft )(greater than 1000 ft
38. Water supply well within 250 ft of the lagoon?
$,On -site ❑ Off -site
39. Distance to WS or HOW (miles):
40. Overtopping from Outside Waters?
41. Constructed before 1993 NRCS Standards?
42. No verification of adherence to 1993 or subsequent
NRCS Standards?
43. Was groundwater encountered during construction?
44. Depth to Groundwater:
45. Spillway?
46. Adequate Marker?
47. Immediate threat to the integrity of the structure?
48. Freeboard & Storm Storage Requirement (inches):
0 Yes 1kNo
5 05-10 0>10
O Yes A No O Unknown
O Yes )No O Unknown
O Yes NoUnknow
P,4�_ *_q)
O Yes O NoxUnknown
Unknown
O Yes lj�No
KYes O No
Oyes XNo
/ /1

Division of Water Quality
Division of Soil and Water Conservation
O Other Agency - - V
Type of Visit . 10 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: / %(M time: :AD Printed on: 7/21/2000
Facility Number -- /
10 Not Operational O Below Threshold
Permitted O Certified 1] Conditionally Certified � Registered Date Last Operated or Above Threshold: ....... .....
Farm Name: ....... .. ............ ... ...... .....
Owner Name:. L�.�a............:........................... Phone No:.................................
Facility Contact:........C.t„tc..............:.f�.. .... .. Title:.....V..(/.:.:.t./............................... Phone No:
Mailing Address: ....... ......
ddress:............. .. V
.. .. ..........
.......Onsite Re resentative:...._{....... p .............L..............................egrator:.........�.IilkCertified Operator:........................................................__............................ Operator Certification Nun
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse --
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Po ulation Cattle Ca aci Po ulation
❑ Wean to Feeder ❑ Layer I ❑ Dairy
der to Finish Z JE1 Non -Layer I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds/Solid Traps
Waste
Present II❑ Lag...n Area I❑ Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If dischar_e is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...........�I........ .................................... ............................... .... .................................... .............................
Freeboard (inches):
5100
❑ Yes KNo
❑ Yes ❑ No
❑ Yes
No
i;��,,��
❑ Yes
❑ No
❑ Yes
krNo
❑ Yes
14 No
❑ Yes kNo
Structure 6
Continued on back

Facility Numbers —,� Date of Inspection U7J Printed on: 7/21/2000
5.
Are there any immediate thTreats to the integrity of any of the structures obs rve ? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes
No
/\
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
iMo
(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
NENo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
,I(No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level '
elevation markings?
❑ Yes
Q'N0
,\
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
o
11.
Is there evidence ojgver app ication? El Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
Q� 10
12.
Crop type l/ //' ,� f7
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
-<No
c) This facility is pended for a wettable acre determination?
❑ Yes
'<No
15.
Does the receiving crop need improvement?
❑ Yes
V?rNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Po
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
,\
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
KNo
19.
Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
&r_No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
4No
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?
fie/ discharge, freeboard problems, over application) ❑ Yes )Q'No
23- Did Reviewer[Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �i3o
24. Does facility require a follow-up visit by same agency? ❑ Yes 1No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [j6o
.. f.. viot....s.. deficiencies were noted itit ... t.... s............. a .. f.. t... .
correspondence. about. this visit.' :' :'.' :' :' ..' ............................ .
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 rd necessary):
/I rye �.lo� `�ha�" -
�a�
Review4rAnspector Name 4- - c»�Pr /y��� Ui �� V,- --
Reviewer/Inspector Signature: /TM i , Y T

Facility.Number. — Date of Inspection evJ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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?
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 ANo
❑ Yes DZNO
❑ Yes XNo
❑ Yes ,'No
❑ Yes IrO
❑ Yes Vo
Additional Comments anitor Drawin
ym,
/&� 3/23/99
l.� ry1v) 3hs-.�soa-�X�zzs
ym,
/&� 3/23/99
l.� ry1v) 3hs-.�soa-�X�zzs

D;Division of Soil and Water Conservation - Operation Review - =
E3 Division of Soil and Water Conservation - Compliance Inspechon _
Division of Watei• Quality -Compliance Inspection 4
OtherAgency;- Operation. Review
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection d 24 hr. (hh:mm)
13 Permitted ��C��ejjlIrt��if`tied__ 0 Conditionally Certified [3 Registered C
Farm Name: V�r'\C� SLR
..........'.�.%.......,,......`1...................................................................................................
Owner Name:._..._......�"�.....
.....................................................................
Facility Contact:
Title:
MailingAddress: .....................................................................................................................
OnsiteRepresentative:. ,,,` . �•:•:�Y.............................................................................
Certified Operator:
Location of F:Wn:
Not Operational I Date Last Operated:
Cou n ty:........:...i^P.IA...........................
Phone No:
Phone No:
................................................ ........ .................. ..........................
Integrator...�,......:.Q.............................................
Operator Certification Number:
Latitude ='=° =" Longitude =• =' =" 5-R Ka
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
,—L8-,Q6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I I ❑ Dairy
❑ Non -Layer I JEI Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
I. Number of Lagoons J❑ Subsurface Drains Present JLJ Lagoon Area IU Spray Field Area I
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
Freeboard (inches): ..-....
....
Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes )4 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
gNo
❑ Yes
%No
❑ Yes
V(No
Structure 6
1/6/99 Continued on back

Facility Number.3 — a r) Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? fie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? _ ❑ Yes Dd No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes q No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes-
fv(No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
WNo
11.
Is there evidence of over application? ❑ Ponding ❑ Nitrogen
❑ Yes
KNo
12.
Crop type ...CcL 4J�. ? �lS........... o a.
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
RNo
14.
Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
( No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
MNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes RfNo
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 ONo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes �Khlo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes UNo
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes M No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes N No
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 9No
24.
Does facility require a follow-up visit by same agency?
❑ Yes [allo
Nu:violationi or deticiencies:were noted dorin Aii viiii:. Yoti wil1'reeeive nh ftiriher : :
• aorrespondehee: abotit: this :visit .:.:..............::::::::::::::::::::::::: :
Comments (refer to question #): Explain any YES answers and/or-any--recommendation"s'or any other comments --
-
Use -drawings of facility to better explain situations. (use additional pages as necessary).: � JI
-
rr — 1
Reviewer/Inspector Name
ReviewerQnspectorSignature: N�'—' `N Date: 312411 11/6/99

Division of Soil and Water Conservation [3 Other Agency
- [nivision of Water Quality w
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review O Other
Date of Inspection d �`
Facility Number Time of Inspection E3 � 2 24 hr. (hh:mm)
13 Registered ;,Certified jE3 Applied jfor Permit 0 Permitted 13 Not —Operational Date Last Operated „_.
Farm Name: .... v` ._5�.1F3 e....5� �.._ ........................... Countv:................... Al\ ...................................................
Owner Name:....... \.......................................................................... Phone No: ..a1.a... ....
iJ ...1 .�..........................
FacilityContact: ...................................1......................q.................. Tititle::........................................v�2.................. Phone N�............................................
hiailingAddress: ........_.W 1 \`^S_1`��........lu`� �� �`t-� � f'o>
.......................................................1........................
Onsite Representative:.._.............................................................................. Integrator: ...... �U�........ :..............................
Certified Operator:............................................................................................................... Operator Certification Number:
Lqptiap,of Fa
!...::........e.::.... ........................._1`........ �SS................t..... �1..............................................v� !- ....... `.. :.............
r ..:....
Iq� .....�.�-•................ _ .....:..: n� w.....:...................
r------ r—t. r—� .. --------- 1-- 1. r---- 7„ ISJA
s
` Design Current '
gn m:.'.
Design Current - Design Cdirrent ;
kSvnne a
,
.Capacity Population
Poultry Capacity, Population Cattie? Capacity Population
❑ Layer =. ❑ Dairy e
`„
❑ Wean to Feeder
r�
'd-0riv
<
-;- ❑ Non -Layer '- ❑Non -Dairy.;:
eeder to Finish
•. ...._ ..; - .,.. .., z
❑ Other
❑ Farrow to Wean
❑Farrow to Feeder
Total Destgp Capacity
Total SSLW,,'
❑ Farrow to Finish
❑ Gilts
Boars
6.�
wF sue:
Number of Lagoons
EAoldmg Ponds ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Fleld Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes fV(No
2. Is any discharge observed from any part of the operation? ❑ Yes ($ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ®,No
c. If discharge is observed, what is the estimated Flow in gal/min? t t /A,,
d. Does discharge bypass a lagoon system? Of yes, notify DWQ) ❑ Yes xNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes MNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes MNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes P(No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 4No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes gNo
7/25/97

4.
1
` Facility Number. 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures(LaeoonsBoldine Ponds, Flush Pits, etc. 1
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
............. .......................................................................................................................
Freeboard(ft):... ,_.A .... �...1................................................................................. ........................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .. f. �.!�v.i24\.../.....: ��...........................................................................
' ❑ Yes
No
❑ Yes
1XNo
Structure 5 Structure 6
...............................................................
.................................................................
❑ Yes
QlNo
❑ Yes
0 No
❑ Yes
O No
❑ Yes
El No
❑ Yes
IEfNo
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
pl No.violations or deficiencies. were noted during this -,visit. YOlt.wiH receive no ftirther .
correspotideitce about this:visit:.
Fz kn�r fi'`'',
KYes ❑ No
❑ Yes O No
❑ Yes ONo
❑ Yes bdNo
❑ Yes 10 No
❑ Yes WNo
XYes ❑ No
❑ Yes KNo
❑ Yes P No
❑ Yes UNo
"- -�\ "Us . ` M--N-
7/25/97

❑ DSWC Animal Feedlot Operation Review
z
® DWQ Animal Feedlot Operation Site Inspection
,
10
t
Routine O Complaint O Follow-up of MVQ inspection O Follow-up of DSW'C review O Other
Bate of Inspection
Facility Number
..........�._.,.......,,,...,.,..,.,..,._ Time of Inspection EELD 24 hr.
0 Registered 0 Certified 0 Applied for Permit E3 Permitted 0 Not Operational 1Date Last Operated: ._.._....- .............
Farm Name: .........
>>Utk.�..... plasi.........F&rrx.......................................................... County: .....
�itl�llT6......................................... .......................
Owner Name: ...... PCW.l.............
//6't''f.!.1................................................................................ Phone No: ... 0.1.9�. ..:.!{.(a.l............................................
Facility Contact: ..... ?QJ...... 6YAd ly.......................................... Title:......{ kU.t.................'...f...................... Phone No:.� gl9a./oS (.-3`%6.I............
ibfailingAddress: ..... 7g7....j1fAi.k... Flasl.-...... .Ra_............................................... .......44q...01.i.Y.C.......N.................................. . �e�......
Onsite Representative: ......1'Atl.l......1' md.1................................................................... Integrator........ Y9.................................................
Certified Operator;......... Nqu1.......... Q......... Gra.� ...................................................... Operator Certification Number:..... J.J.&q.5r ...................
Location of Farm:
"Swine Capacity rPopulation Poultry Capacity, Population Cattle - Capacity Population
❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity 7,130
❑ Gilts
❑ Boars Total SSLW 1Bvtoo
Number' of Lagoons / Holding Ponds © Subsurface Drains Present ❑Lagoon Area I$ Spray Field Area
- ❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? []Yes RrNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes )BNo
b. if dischargc is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 0 No
c. If discharge is observed, what is the estimated Flow in gal/min9 t,1ZA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes O No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ,19 No
7/25/97 Continued on back

tR:
F Scity Number: 3 EHE
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Lagoons Holding Ponds. Flush Pits, etc.i
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3. Structure 4
Identifier:
Freeboard (tt): ......2 3....... _....... ....
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 ADDlication
❑ Yes IgNo
❑ Yes
�Z No
Structure 5 Structure 6
...............................................................
.................................................................
❑ Yes
''No
❑ Yes
JENo
Qq Yes
❑ No
❑ Yes R No
14. Is there physical evidence of over application? ❑ Yes [,9 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................�! Y1..............................................................W ................................... ..................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? 10 Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping heed improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
® No violation§ or deficiencies were noted during this.visit. You.will receive no further
....... ........ . ...... . ...... . ...... . ...... .....
correspondence about this visit.
to
s. k e¢rtE,.l t.-11N- 41
12. L_ o Saot. yA`IS S6Uld
0&iq W ,t tweeted,
a�d>1a
YES answers an
❑ Yes Q No
❑ Yes Da No
❑ Yes ® No
❑ Yes .a No
❑ Yes C9 No
lgi Yes ❑ No
❑ Yes ® No
❑ Yes [9 No
❑ Yes 19 No
Sei vP a odu^;Au., Fige..
�P G
(b' boi�ci'
Fran diielus. .._
be- r4w4, "-,ON cA
oa
it[fttq— WAIJ
4hoold 6e AlIti
cvi,L
Ca Ack Golds bovo ko5 fov- Ve64icAnl a sprt� Ae(d
u. spro�y fads S64 be f by
etrgly s:s Sb ov� 6 iv\ aerii�;e Plfh.
t)sdc_ifA lvtnn�4 \, USirta \RR-Z For
rut. Avmkev, old A'A ftbyh6r, Wcuw wasEe
Wafter, 64avue it. s�rwY FTclds sl1oJ(d IoC
t 'T _t _.It t. Nln.r 7/25/97
Reviewer/Inspector Name i
Reviewer/Inspector Signature:_ /. 1 ADate:

11
•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO S SITE VISITATION RECORD
DATE: Z 6 11995
Time: '% z. 05�
/ /ram /
Farm Name/Owner: �/n/ �l l'�e �� t�Fti /"/L7 PGGv`-'! G ✓'c
Mailing Address: T
County:
Integrator -
On Site Representative:
Physical Address/Location: _
Type of Operation: Swine
Design Capacity: , 2.6
Phone:
Phone:
Poultry _ Cattle
Number of Animals on Site:
--3�/6/
DEM Cerdficad n Number: ACE 77D%%EM Cerdfican n Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 0 or No Actual Freeboard: _�' Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oroas any erosion observed? Yes of
Is adequate land available for spray? e r No/ Is cover crop adequate? Yes or No
Crop(s) being utilized: 4rzlr� efqz
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o�dVo )
Is animal waste discharged into waters of state by man-made ditch, flushing system, or other l�
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 cr9p)? 6* or No
Comments:
,1/'A//
� �1 JVt IJ11. S 11� rdf�' I
.. Inspector Name
cc: Facility Assessment Unit
S. nature
Use Attachments if Needed.