310272_INSPECTIONS_20171231

NOHTH CAHULINA
Department of Environmental Qual

Type of Visit: m Co ance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: OD County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact:
Title:
Onsite Representative:
�hk 5 .� - t1. j
('
..3 4"-, ,
t
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: f 7 3 O k--
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Myer
Wet Poultry
Design
Capacity
C*urrent
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
)ktlan to Feeder
I
jNon-Layer
I
Dairy Calf
Dairy Heifer
eeder to Finish 24
Farrow to Wean
D , P,oult
Lavers
Design
C•_a aci
to ,
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
i I
n
Beef Feeder
Beef Brood Cow
M
Boars
Other
Other
Discharees 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 Q "" ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [T] No ❑ NA ❑ NE
❑ Yes FrNo ❑ NA ❑ NE
Page l of 3 21412015 Continued

Facility Ndmber: 113ate of Inspection: 12 !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes D<o . ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesF2/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 U No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes � Z.
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ;
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes g�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 CNo ❑ 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 d4o ❑ 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

Facility Number: r3- Date of Inspection: l
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6'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 ETNo ❑ NSA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No [ a A ❑ 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 ONo
❑ Yes M-No.
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes L_d"1`� ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes No
❑ Yes F!rxo
❑ Yes ENO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments. (refert©.question.#) Egp in any YES: answers and/or any,additional recommendations or>any-other comments
Use drawings of facility to better explam,situations (use additionali pages as necessary):.,.. .-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g 0 If t y
Date:
21412015

Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 19 [ Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ` ( A.v^- -f - SAr7 G_r(
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: /7?
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
I 11-ayer
Design
Capacity
Current
Pop.
Design Current
C►attle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P■oul
Layers
Design
Ca aci
Current
P,o ..
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
Turkeys
urkey 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 [ To ❑ NA ❑ NE
[:)Yes [:)No
[:)Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes []'�To ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Facili Number: 3- 2 77 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 22'�
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 2 o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes la< ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E2 "o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ l o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[TNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ej N ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑'No u 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
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
21<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
CJNo ❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ffNo ❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Fadli Number: - G Date of Ins ectiom
24. Did the facility fail to calibrate waste application equipment as required by the p t. ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[—]Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑` l4A
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[314o ❑ 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:
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? []Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ff No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers "and/or any additional recommendations or any other -comments. -
Use drawinas of facility to better explain situations (use additional panes as necessary).
Off _3 oa /[,
C� 4- rp Sr of oo1,s Wyen j_7S 0�
Reviewer/Inspector Name: �i(y+� C- �n �- / Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

- Division of -Water Quality
Facility Number 3 I IMILam'_ ] O Division of Soil and Water Gonservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qf Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - - CArrival Time: p[:OD pM Departure Time: County:
Farm Name: _TOvr-+ .]� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Region: 4/.AOO
Certification Number: 1 / 30 �
Certification Number:
Longitude:
Swine
Wean to Finish
Design C►urrent
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Design
Cattle Capacity
Dairy Cow
Dairy Calf
Current
Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
9L 64 p
Design Current
D Pooutt . Ca .aci_ P,o
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
10ther
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)?
❑ Yes VfNo [DNA ❑ NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes K No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EfNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

. Facility Number: jDate of Inspection: - 3-j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
F] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,❑ 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
t� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
C�TNo
DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
VrNo
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
C ] 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?
.r.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑Yes
VNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E5 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2� No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
gNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Callo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�J`No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ga-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L?fNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [;�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? [:]Yes P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility• Number: - Date of Ins ection: J4
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
Tr%[rNo
`�
❑ NA ❑ NE
the appropriate box(es) below.
f
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
P No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[-]Yes
�rNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
PfNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Wy 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
ONo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[—]Yes
ONo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
Reviewer/Inspector Name: _T Phone: aSa- 36I -.2a52
Reviewer/Inspector Signature: ��_ .t, Date:
Page 3 of 3 21412014

Type of Visit: 7Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: �7ioutiue O Complaint O Follow-up 0 Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: 'To fir. '5+r24 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: —T kLt mws L" 'S+V1M
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
h
Swine Capacity Pap.E!!!
Design Current Design Current
Dai Cow
acity PoWtoFeeder
1Hder
er
DairyCalf
sh
an
Farrow to Finish
�
DairyHeifer
Design Current D Cow
I) . P,oul C+a aci P,o , Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
F Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Z] No
[:]Yes P3 No
❑ Yes 7] No
[:]Yes J'No
❑ Yes E�No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

r
Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): { `
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RfNo ❑ NA ONE
(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 ZfNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes j6 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste ARPlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Of No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes F5 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes J' No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ;�!r No ❑ NA ❑ NE
❑ Yes Z] No ❑ NA ❑ NE
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 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 .0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EfNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
[DNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes ZlNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EJ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes gfNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �_ej No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations'or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
PARL&C -�Aq_f VN Czr(VV11dt1f1.
Lato&^
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
5vr4t+ sF_VApa .
Phone: p ���'�
Alai Date: J
21412011

' iv`is`ion of Water Quality
Facility NumbeDivision of Soil and Water Conservation
®Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: 3 1 Arrival Time: Departure Time: County: Ulf/ Region:
Farm Name: !bm S'1 Gem". Owner Email:
Owner Name: RS L ; �to�h �GL. Phone: (o9 SD) S&� —g9Vr 9
Mailing Address: j 0Q0 Pg t4C_ G am'\ LN j4(-! e+u—jsa,v , Nc 0'5�- SC S --<5 L/y 5
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
idm 1 Q'j >
In egrator:
6or /a
Certified Operator: �}jC1j)jA5
L,
Certification Number:
?
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
EE]
DairyCalf
Feeder to Finish
(p
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,oult .
Ca aci,
P,o ,
Non -Dairy
Farrow to Finish
Layers
113cef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
7No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: -949Date of Inspection:
Waste Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tNo
o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LACICO14
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 environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �6 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
VkNo
❑ 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 CropWind/owl ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
�
12. Crop Type(s): se, b'Egt ;)
13. Soil Type(s): AlATfiZ�AUI Lt-.E
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
'A No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
DWUP ❑Checklists QDesign Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
bqNo
❑ NA
❑ NE
❑ Waste Application Q Weekly Freeboard Q Waste Analysis [] Soil Analysis ❑ /aste Transfers Q Weather Code
0 Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: `'-,I - Date of Inspection: Ple9311,9
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 7kNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes $ No ❑ NA ❑ NE
❑ Yes 56 No ❑ NA ❑ NE
❑ Yes j No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes -No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ YesjNo ❑ 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). r
Q RN E ON CL�47p — 1/1&�l e L-koala
��►fin d� �� �►a
l6Ig�0Il l
I • $
3. D
Reviewer/Inspector Name: Auqlw C� i�//��S Phone: q16
Reviewer/Inspector Signature: - Date: OQt)3/Q
Page 3 of 3 21412011

+ Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- - - 0 Other Agency
Type of Visit Z2 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routlne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9 �{`� Departure Time: County: UAI Region:
Farm Name: �6cn J �� t� 2 i� Owner Email: (�
Owner Name: "om A Phone cd S 68! q
(0_9
Mailing Address: �� PgjA C 69- 40�A Lev !-y 63 E;�M_dS/,�
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Sn Y �
Certified Operator:�rY1
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Integr tor: 1
bzo�
Operator Certification Number:
Back-up Certification Number:
Latitude: =]' [—]' ❑ Longitude: = ° = ` = {!
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er I I =]
❑ Non -La er
Dry Poultry
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
E]Dry
Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures -
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
ElNA
ElNE
ElYes
No
❑ NA
❑ NE
12128104 Continued

L
Facility Number: 3 (— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes El No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 'OON
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes kNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 4No. ❑ 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 4'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes jNo ❑ NA ❑ NE
maintenance/improvement? v
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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 Windt El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) SG � it
13. Soil type(s) Ac rr[z�.��l L-LZ--
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
1 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
o
❑ NA
❑ NE
-Comments
(refer to question #); Explain .any YES. answer"s a'n/or any ,recomm°endations or any other.co ents
-
Use drawings of facility to better explain situahons (use additional pages as necessary) a
Reviewer/Inspector Name �, 1N %F Phone:
Reviewer/lnspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: f — I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis El Soil Analysis El./aste Transfers 1,❑Xnual Certification
EIRainfall []Stocking 0 Crop Yield 0 120 Minute Inspections El Monthly and V Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ' No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes . No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 11✓✓��❑�`�`No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
Af 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 allo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Sts&DCE AXE AAF1
C_AugCL(rT'C)H
LA->-
a131<< a.o
a
Page 3 of 3 12128104

O Dtvrsron of Water Quality
Facility Number C a ,� _O Dfviseon of Soil and Water C©nservatfon
=F
O Other: Agepcy:
f
Type of Visit 0 Compliance Inspection Q�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 Visil: arrival Time: Departure "Time: i County:
Farm \ame: �'n O Owner Entail:
Owner Narne: J= � oU'/ Phone:
,Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Other -
ID Other
Phone No:
Operator Certification `umber:
Back-up Certification Number:
n: Ia
Latitude: ao Longitude: =o = 1 = U
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
Pullets
Other
Dishes & 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
❑
Daity Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: T]
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 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
El NA
El NE'
❑ Yes
;dNo
❑ NA
❑ NE
12128104 Confinued

Facility Number: 31—jZ
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 Stricture 2 Structure 3 Stricture 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S 6
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 i Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes jfNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ElNA ElNE
maintenance or improvement? k
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of ind & ❑ Application Outside of Area
12. Crop type(s)'�
13. Soil type(s)j�'��
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
W
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]YesNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name .11111 Phone:
Reviewer/Inspector Signature: Date:
lZ1Z8104 GonUnued

Facility Number: '91 — Date of Inspection
Required Records & Documents_
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )KNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes yNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o El NA
El
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYesjNo
❑NA
ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yeso
❑ NA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYeso
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑Yeso
❑ NA
❑ NE
X
2
7. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElYesNo ❑ NA ❑ NE
f)thI Issoes
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ YesalloNo ❑ NA El NE
❑ Yes ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
❑ Yes NNo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
A.
12129104

Type of Visit Compliance Inspection U Operation Review Q Structure Evaluation V Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: n=Arrival Time: ® Departure Time: County: l /V _ Region:
Farm Name: fly 12ot.A�� Fp�t Owner Email:
Owner Name: Phone: gSQ_5(.p8 -
(y Mailing Address: I PAW— AL1Q--f5cw `Y C �Q C� I yys
Physical Address:
Facility Contact: Title:
Onsite Representative: 6M j
Certified Operator::I
Back-up Operator:
Phone No:
Integrat
(!�s
Operator Certification Number: V3 U
Back-up Certification Number:
Location of Farm: Latitude: [= o = 6 = 6, Longitude: = ° = 6 =
Design Current
Design Eurrent
Design
Current
Swine Capacity Population
Wet Poultry C*apacity Population
C*at#le Capacity
Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
El Dairy
Calf
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ElYes $No ElNA ❑ NE
Discharge originated at: ❑ Structure ElApplication Field ElOther
a. Was the conveyance man-made? [IYes [INo ElNA ElNE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ElYes ❑ No ElNA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ElNo ElNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ANo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ElYes )<No [INA ❑ NE
other than from a discharge?
12128104 Continued

Facility Number: j —
Date of Inspection �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
El NA El NE
[I NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Clq(' 0O"j
❑ Yes XNo
❑ Yes ❑ No
Spillway?: Q
Designed Freeboard (in):
Observed Freeboard (in): p A
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ElNA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes] No ❑ NA ❑ NE
maintenance/improvement? \
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes .J�,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C, e t= C14
13. Soil type(s) ()LATQ k,O1 Lam. 6 .-
J
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RLNo
❑ NA
❑ NE
Comments refer to question # : Explain an YES answers and/or any recommendations or an other comments.y
( q ) P Y y y
Use.drawings of facility to better: explain situations. (use additional pages as necessary) �", #
77X
Reviewer/Inspector Name R./vDA- 6,oi e-5 Phone: 910--+496-�394
Reviewer/Inspector Signature: _ ct.drt Date: 3 %I/ ) )0
12128104 Continued

Facility Number: -3 ( —,q"Date of Inspection 1 I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists 0 Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ElYes JA No El NA El NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ jaste Transfers ❑ Aj&ual Certification
0 Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections El Monthly and 1" Rain Inspections E]Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
5�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
)qNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
X 1tiona1 Commeht0* d or Dra i
AL
iJ�sl�� I.s
)09
12(2&04

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ate Departure Time. County: e U/y Region:
Farm Name: —1-0 m ST 4R-oult� 1— A Q_ rn Owner Email:
Owner Name: �oFni4 s L - S—r 2UsL Phone:�f �Og
Mailing Address: I a� PAC.IL L'��,R� Lo AC_ � i SO�1/� /V CWQ
Physical Address:
Facility Contact: Title:
Onsite Representative: d�
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =1 = Longitude: = ° 01 = ,I
Swine
Design Current
Capacity Population Wet Poultry
❑ Layer
Design C*urrent Design Current
C*apacity Population Cattle C*apacity Population
I ❑Dai Cow
❑ Wean to Finish
❑ Wean to Feeder
ID Non -Layer
I I❑Dai Calf
eeder to Finish
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
ElFarrow to Finish
El Non-Layers
❑ Beef Stocker
El Gilts
[I Beef Feeder
❑ Boars
El Pullets
❑Beef Brood Cow J
❑ Turkeys
Other
❑Turke Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes ANo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
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

Date of Inspection .)LU
-12-11
Facility Number: f -
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: LA G-c-cy C
Spillway?:
Designed Freeboard (in): 19, S
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes/
No ❑ NA ❑ NE
through a waste management or closure plan?
,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
&No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ElNA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
,�No
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
o ElNA ❑ NE
k
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
X'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � � 14
13. Soil type(s)
LUE
V
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ANo
❑ NA
(3 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
&o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gNo
❑ NA
❑ NE
to e ., � ,i
Commepts (refer to quest<on;#) Explain arty YES'answers and/or any recornmendaho ' ns orb y�other,comments:�
Use drawings pf facii�ty,. to, better explain situations. (use additional pages as necessary):
CAC. `jeSIC1VkT1CW trlC_t i� prtiT�t L�Ic.LS LACCIR
J74Q tA- LOOWS3 (!�ZOOk�
Reviewer/InspectorName %VQ%9 G PWAJES Phone: v��r
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: } 02 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 4No ❑ NA ❑ NE
the appropirate box.
0 WUP El Checklists 0 Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ` ❑ Yes [jNo ElNA ❑ NE
0 Waste Application ElWeekly Freeboard ElWaste Analysis ❑ Soil Analysis ❑/aste Transfers ❑ Anual Certification
El Rainfall ❑ Stocking 0 Crop Yield El 120 Minute Inspections ❑ Monthly and V Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
A No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ym No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,WNo
❑ 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
ONo
❑ 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
E&
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
'�No
❑ NA
❑ NE
Addidonal.ColnMents and/orbrarvrIii
ngs.
Page 3 of 3 I2/28/04

0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- -- 0 Other Agency
Type of Visit ?& compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: >U 3 Departure Time: County: l A/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative:—) N-nm a S Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 4 Longitude: = ° = S = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current'
Cattle Capacity Population,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number:_31 p'A Date of Inspection 3? 6
Waste Collection & Treatment
4. Is storage capacity (structural -plus storm storage plus heavy rainfall) less than adequate?
❑ Yes )4No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L-RIGOQ14
Spillway?:
Designed Freeboard (in):
Freeboard 3
Observed (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes allo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes IQ 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 [Sj No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
WasteAvolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [?No
❑ NA ❑ NE
maintenance/improvement`?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes P No
❑ NA ❑ NE
❑ Excessive Ponding [:1 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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
O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�?No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
q No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
( No
❑ NA
❑ NE
18, is there a lack of properly operating waste application equipment?
❑ Yes
R No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
j. CET LA6oaN sinM,"ray-� cConA Sd1C_v
sN EET
Reviewer/inspector Name M.4NPoq GAW6S Phone:Reviewer/inspector Signature: Date: 1! 1 I

Facility Number: Date of Inspection 7�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ® Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists 191 Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[] No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fait to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[0 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
MY No
[INA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
10 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E]No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
_......_ .__ Q Other Agency
Type of Visit JO Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
/�
Date of Visit: Arrival Time: parture Time: 19 -,�OC unty: ���GZl)l Region:
Farm Name: _ S Owner Email:
Owner Name: _ _ / AS iP�J% Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [—] o =' = Longitude: 0 0 ❑ ` "
Design ..CurrentDesign Current
Swine Capacity Population
i
~: ❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish rj
Farrow to Wean
i
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other .
❑ Other
Wet Poultry Capacity Population
�- ❑ Layer
❑ Non -Layer
Dry Poultry
Pullets
.Turkeys
Turkey Poults
Other l T
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 Curren
Cattle Capacity Populatic
L! Dairy Cow c
E]Dairy Calf
❑ Dairy Heifer
❑ Dry Cow [
❑ Non -Dairy
L"
❑ Beef Stocker
❑ Beef Feeder k
❑ Beef Brood Co
Number of Structures -.,.
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
YNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

Facility Number: —Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ElNE
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?: 0
Designed Freeboard (in):
Observed Freeboard (in): _ 20
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes yJ No
[INA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
ElNE
maintenance or improvement?
/
Waste Auttlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑�No ❑ NA El NE
❑ Excessive Ponding [I Hydraulic Overload ❑ Frozen Ground El 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 Prift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
Cl Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JNo ❑ 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'additionatpages as necessary)
rJf6L� �,S
� J i��✓o061 ��2 i`-���z���2 � �o 4J
Reviewer/tnspectorName S�� 'p I Phone: jd)
Reviewer/inspector Signature: Date: / Q.
Page 2 of 3 121281 Continued

Facility Number: —Z Date of Inspection
Required Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes�ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [lNo [INA ElNE
the appropriate box. /
❑ WUP ❑Checklists El Design ❑Maps El Other
2 L
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 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 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
X�'No
El Yes �No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
/Additional Comments and/or Drawings: .
❑ Yes
z No
ElNA
ElNE
ElYes
No
❑ NA
❑ NE
❑ Yes
['No
/[XNo
El NA
El NE
El Yes
❑ NA
❑ NE
❑ Yes
No
[I NA
❑ NE
❑ Yes
F(No
❑ NA
❑ NE
Page 3 of 3 I212RI04

1J
Facility Number 2 ��
Qf Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 E-mergency 0 Other El Denied Access, / Q�
Date of Visit: I Fj !/�� Arrival Time: ,' Departure Time: County: Region:
Farm Name: �io'1 5 �ST�Ouo� Owner Email:
Owner Name: L . Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �047 �r,PD
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No: )j
Integrator: Aepll��- O4_7N
Operator Certification Number:
Back-up Certification Number:
Latitude: c ` " Longitude:
Design:.Current Design" Current Design Gurrent,�
Swine Capacity Population Wet Poultry Capacity hPopulation Catte Capacity" � Po ulation�"`
❑ Wean to Finish
' 10 Layer
❑ Wean to Feeder
" ❑Non -La er
Feeder to Finish-
Dry Poultry
❑ Farrow to Wean
❑ Farrow to Feeder
a
❑ Lers
❑ Farrow to Finish
Gilts
'Other
" ❑ Other - — - -
U Non -La ers
❑ Pullets
- -�
❑ Turkeys
❑ Turkey Poults
�f-
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures.,
/ 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?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
yNo
❑ NA
❑ NE
12128104
Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier:
Spillway?: / /7
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
❑ Yes No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA ❑NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
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 1E1 ❑ El
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ �dNo
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 �No ❑ NA El 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of�Acccccee table Crop WinA-,
❑ Evidence f Wind Drift ❑ pplication Outside of Area
12. Croptype(s) ll 1�1��/� 1�✓ �_ �.�J• ���'.._.
13. Soil type(s) /I I/ I
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes leNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes X No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? I] Yes XYo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ 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):
I6') 2 /N/P5 J �cG / �G ZZ^Za & !rJ/4�j L,/%i 4
21) 40P 60 0-C7
�Pac lO �ifS>�1`�✓ �il�D,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone: O- 6--
Date: At
12128104 Continued

Facility Number: —� Date of Inspection
Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
❑ Yes XNo ❑ NA ❑ NE
❑ Yes 0 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 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ,ZN.
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes XNo
❑ 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 CAWW?
❑ Yes No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ YesNo
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately
444444 ,
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes (No
❑ NA
❑ NE
Additional Comments and/or Drawings:
2, RC o r -&6,p UP e-I-l�
Page 3 of 3 12128104

.Qf Division of V4'a#er Quality
s acility umber LAD '2 O Division of Soil and Water C•anservatian
Other Agency
Type of Visit P Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 9) Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1315 05 I Arrival Time: ;$ Departure Time: �ounty: 14 Region: �2D
1
Farm Name: �a�'1- i D u� f�2m Owner Email:
f�
Owner Name: �� A �y/Z 0u,0 Phone:
Mailing Address:
Physical Address:
Facility Contact: —� Title: Phone No:
Onsite Representative: 1�eoy'o---,---.. _--_ Integrator: _ Q2�U `S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Operator Certification Number:
Back-up Certification Number:
�o
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er k
_ ❑ Non -Layer -- _
Other
❑ Other - -- --- - -
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: = ° = ` =
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Humber of Structures: M
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 PfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
% No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
12128104 Continued

Facility Number: —Z 2
Date of Inspection 3 D
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?
❑NA El NE
El NA El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �V
Spillway?: No
Designed Freeboard (in): lg, 5-
Observed Freeboard (in): Z�
❑ Yes No
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 10 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 oft he structures need maintenance or improvement? ❑ Yes IVNoEl NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El /� No ElNA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Apmlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) 2�i?/I)!!p o LmLl) ,�, a�
13. Soil type(s) ?'x—&z tte '
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes A No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the -irrigation design or wettable acre determination? ❑ Yes ZZ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes � No El NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
6 ale!yG6Ti9zeJ.�D,
Reviewerllnspector Name�il!3 Phone: 9/O—3�S-3Q�;�T.Zl�
Reviewer/inspector Signature:
Date:
12128104 Continued

. . .
Facility Number: 3 % — ZZ Date of Inspection 3 O
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VrNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other .
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
14
Z No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
gNE
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
VrNo
❑ 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
IN o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
/fNo
❑ 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
A No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
CVC
ZZA
-
j 1, O 7orJ5 GVrnF.�0� _
46
12128104

,ePermitted
Certified [3 Conditionally Certified 0 Registered
Above Threshold:
OwnerName: _ .......................................... ..........................».................................._........ Phone No: ..............
_.........._...._........_........_W.... __... .
MailingAddress: ........................................ ............... ..........................................
Facility Contact: .................... ..................... ............. .__.._............. Title: Phone No:
Onsite Representative: q_aJOVD Integrator:
Certified Operator:._..... _...._....... _..... _ .. _ _....._----...._._-------- --- Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �d 46 Longitude • 4 C&
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 ❑ N
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 o
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 b
Identifier: ..._....._. l.................... ...................... .. _........ _....... _.. _ _ _.- -- .. _ ....._.._ ...�
Freeboard (inches): 2
12112103 Continued

I~9cility Number: —Z 2 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes INoZ
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes N
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes N
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type @6emVM H S G 6
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes VNo
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 No
15. Does the receiving crop need improvement? ❑ Yes o
16. Is there a lack of adequate waste application equipment? ❑ Yes l� No
q PP eq P
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 2f400
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Courments (refer�to question #) anyYESans a and/or any recc►m adatzoasor aay othermuitw
.Use drawuags of facjhty tc► better exglatn�srtuattoas. (use;addt�ona! pages as necessary) lFei d Cop Final Notes
G-a-J'
Reviewerllnspector Name' tl
Reviewer/Inspector Signature: Date: 2.[�
16/16/U1 1. B unueu

Facility Number: al — L7 Date of Inspection d
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 4o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? �40
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes L�1 N
28. Does facility require a follow-up visit by same agency? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Io
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 04es ❑ N
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes :Nql
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes V[3N
34. Did the facility fail to calibrate waste application equipment? ❑ Yes35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes '�' 0
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
12112103

Type of Visit )0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit iRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
{ Date or visit -
Permitted Z�Z
Permirtted [I Certified ❑ Conditionally Certified Registered
Farm Nance:.._....... -..a ........
Owner Name: 0... . "..Wza-
Mailing Address:
.� Tirne: LA9,90
NNot Operational Q Below Threshoid
Date Last Operated Above Threshold: ............
county: ....... GZnJ....................
Phone No:
FacilityContact: ............................................... .................. Title: ............ ...... ....................................... Phone No:......................
Onsite Representative:..._..._ ................. _/ // o.........._I....................._. Lsteerator. ,/�/ 1�. -r _ ........_....
Certified Operator:
Location of Farm:
Operator Certification Number:... .......................................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude - "'`" Longitude
Wean to Feeder
<> ❑ Layer
>
❑ Dairy
Feeder to Finish
= Non
>
❑Non -Dairy
Farrow- to Wean
:=
: ❑ Other
Farrow to Feeder
Farrow to Finish
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 )tNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ..................... ......................_ . ......_.............. ........... ................................................................................................
Freeboard (inches): .........& ..............................

Fact3ity Number. I Z Date of Inspection
5. Are there any iinmeZnare threats to the integrity of any of the structures observed? (iic/�trees, severe erosion,
seepage, etc.)
6. Are there structure—_ on -site whicu 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 maintenancefimprovement?
8. Does any part of the waste management system other than waste structures require maintenanceJiinaprovement?
9. Do any stuctures lack adequate, ganged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10- Are there any buffers that need. maintenance/improvement?
11. Ls there evidence of over application? / Excessive Ponding%❑ PAN MraulicOverloa
12. Crop type 9"— InIjAq �/f�� S/1jRG1, 1 r/WAU
13. Do the receiving crops differ with those designated in the Certified -Animal Waste Management Plan
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acne 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?
Yes /No
Yes Ao
❑ Yes No
❑ Yes j�No
Yes .. V(No
❑ Yes VNo
J, /� Yes ❑ No
(/mac///l7 1'
WMP)?
Reouired 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/'%UP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis &. soil sample reports)
20. Is far_;liiy not in compliance with my applicable setback criteria in effect at the time of design?
21. Did the fs6lityfail to have a actively certified operator in charge?
22..Fail to notify regional DWQ of emergencysituations as required by General Permit?
Cie/ discharge, freeboard problems, over application)
-23.. Did Reviewer/Inspector fail to discuss reviewAnspection with on -site representative?
24. Does facility require a follow-up visit by -some agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? .
Yes Ao
El Yes o
❑ Yes o
❑ Yes ❑ No
❑ Yes XIND
Yes No
❑ Yes Y(No
❑ Yes 0NNo
❑ Yes No
❑ Yes o
.l.] Yes No
.El -yes No
El Yes I No
❑ Yes .VNo
❑Yes 'WNIo
© Nor olations or deficiencies-werenoted during this vislt You will receive no further correspondence about this •visit.
...
�i� Atii�FY1�4�f►.�'�finMl�` ..gs.. �-�*>•,...,�..,;:t�'-.;�r..:::'...�:�..•.::::ici
�µv���Field Copy A❑ FiFial Notes
;` }, k .� 2 } h' Y' ^GC'i.:ii<{:..::V{.
]{� 52h. L �`' { } 3 SN i ..« ::;,t`::%tk S ic'^>:LC.:: {•ACE�.•�.
SE:.._.:::::.::•........vv:,-.:.:::::::v.x:tv.:::. x..n:,:::-._.:.x.:: _....:..::..: .......:.. ..:._. ..:-.::.:..:.:.:-....:.:-:.:..-:.x,:.::.:2�...-.:�:::.::,+:::.::.vv:.:v:::.v ni,.e...tvwv:::..�C�..`"..LF+�-.L:.E��'.C�__"__"S •.
qqr
• :r.; ,Vu: xLcr:....:.....,,......... ;; .r........v:::..,y,..n C:{^:' - �.y:. :%inYd: :.:4}}: Jyxh:-%Y.�::::v :4}f: i<itN.?•
��y _
Revtewerllns or Name.<. _ �. .- --
C1iL
p
Reviewer/Inspector Signature: Date:

Facility Number. Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
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 VNo
❑ Yes //❑ No
❑ Yes o
❑ Yes 1;Ko
❑ Yes 1p o
❑ YeX11N,
❑ Yes ❑ No
Additional Comments and/or Drawings:
P?)
��hSr C. ��G� G��7� �rG� y �j��s�ar✓ �8©��
�r
6 r
O5103101

t utviton of Water Qttality -
Q:ptVisiott ofSOtl attd_- ►ii1sG1 COrrTrl •a
r'Q €N1ter. Agency 3
= .x -
Type of Visit - )q Compliance inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: - l I Time: � Q
Facility Number
Q Not Operational Q Below Threshold
dPermitted © Certified [3 Conditionally Certified 13 Registered Date Last Operated orbove Threshold: .........................
m FarName: .... ....i. k_.,. Ax .. County: .... 1L......-..riI.........................................................
............................................................................
OwnerName:........................................................................................................................... Phone No:
Facility Contact: .............................................................................. Title:....................- Phone No:
MailingAddress:........................................-------........................................
Onsite Representative- W O.•-�tr •• Integrator: .) - ...................... [ ....................._....-------- -----.
Certified Operator:..,.................................--,,.......,.........,...................................................... Operator Certification Number:
Location'of Farm:
qr
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �« Longitude �• �� ���
Current Cuntgn
-Design
Swine CattlePo abon Poultry CC__ _ Po uat1o1iCa actul
❑ Wean to Feeder ❑ Layer ❑Dairy -
Feeder to Finish Q n Non -Layer I Non -Dairy
ri Farrow to Wean -
❑ Farrow to Feeder ❑Other =
❑ Farrow to Finish Tonal Des gn•Capacity:
❑ Gilts
I[] Boars T6W SSI W
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Fietd Are; `»
H61ding Ponds 1 Solld Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: [ILagoon [3Spray 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
M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
64 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
PfNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Idcn ti fier:.................................... ................................... .................................... ....................................
................. ..... ..............
Freeboard (inches): a3
5/00
Continued on back

Facility Number: Date of Inspection Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management of
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
10/26/2000
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
"caste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WL P, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
No . iolatigns :or clef ciebcies -were noted dtWiitg phis;visit; - YoWwill •reeeive tno 4ther ;
corres orideike: abouti this visit.
❑ Yes No
❑ Yes j No
0 Yes � No
❑ Yes No
❑ Yes O No
❑ Yes �rNo
❑ Yes PjNo
❑ Yes XNo
❑ Yes K No
❑ Yes t< No
❑ Yes JXNo
DE�yes ❑ No
❑ Yes X No
❑ Yes �fNo
❑ Yes N No
❑ Yes VNo
❑ Yes No
❑ Yes No
❑ Yes Q5No
❑ Yes C•No
❑ Yes Dr No
❑ Yes CjrNo
Comments_(refer to question #): Explain any -YES.answers and/or any.recommendations or any oilier comments..'
Use.drawings of. facility tq better explain situations; -(use _ additionial pages as necessary)., -
. S-1 �� �-s�e � -�L,e ►�►ti,_��e,� -�-+� ��� le.� Q� C��►--, Rec��►�
<7-0 n 11 c ! C,`-1. ri s L2fI'l i t,o tfae j r2�c,ct? �w,� . •
Reviewer/Inspector Name 2L�►-�V�t--R�Q,
Reviewer/Inspector Signature: �__ Date: fi} 5/00

Facility Number:'3 ( -g37,1-1 Date of Inspection �dl (of Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes WNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PNO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes #No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 19 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged till pipe or a permanent/temporary cover? ❑ Yes No
AdditionaMomments.an or rawtngs:.
a
Ila
5/00

_0 D�v�sron of Soil and WaterConsery-_`_©peraton Renew W;
('Division of Soil and Water Conservation _ Compliance InSpeC�OA p r
k
Divisionof Water Quality :yComphanee Inspection ffi k v =ter
Other_ -Agency;, Operation Review �. .
ILRoutine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number Date of Inspection l
Time of Inspection a'L 0 24 hr. (hh:mm)
*Permitted ❑ Certified [3 Conditionally Certified ❑ Registered [3 Not Operational 1 Date Last Operated:
Farm Name: ...... County......
......).G......................................................................................... ... ...........................................................
...
OwnerName:........................................................................................................................... Phone No:
Facility Contact: ............
... Title:
Phone No:
MailingAddress: .............�...j............................................................................................................................................................ I.,.......................
Onsite Representative:4.� �l`iLQ�Inte ratorti�IG
................................................................................... g .......... ................................................................
Certified Operator:
Location of Farm-
.. Operator Certification Number:
Latitude • ° 14 Longitude 0 ° 44
- Design- Current Design Current -Design.-> -.Current,
:.Swine Capacity Population Poultry Ca acity =Population Cattle Ca 'act ::'Population
❑ Wean to Feeder ❑ Layer 1 10 Dairy
Feeder to Finish 0 ❑ Non -Layer ❑ Non -Dairy
-❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other -
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total`SSL•-W
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ©spray Field Area
Holding Ponds I. Solid Traps ❑ No Liquid Waste Management System =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes NrNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes El No
b. If discharge is observed, did it reach Water of [he Slate? (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)
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:
Freeboard (inches): .............371 .........
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes ONo
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes KNo
Continued on back

Facilily Number, t —a Date of Inspection
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
$. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidegce of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type �ti , Sq , W G
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
IS. 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 reviewlinspection 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?
U: .To •yi61h i6tis:oe- de#ici6ndbi s •were nQtet3- tliti'irig this:visit: - Y:ott Wiil-receiye d further • :. :
ctirres ... onciefnce: abatit this :visit: ..........:: .
Comments'{refer to question #)i Explain any YES aiiswers andlor atiy recommenilAons or anv other comnie
Ilse drawings of facility to better_ explain.situations (use additional pages asinecessaiy}
Z
cvlav_ 1. t_,�
, (:��
❑ Yes )dNo
❑ Yes XNo
AV Yes b�`Nq�
bZ'Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes J�(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes kNo
❑ Yes f No
❑ Yes )Z No
❑ Yes ONO
❑ Yes tTNo
❑ Yes ONO
❑ Yes 10 No
❑ Yes kNo
❑ Yes gNo
WYes ❑ No
❑ Yes ONO
Reviewer/Inspector Name`
Reviewer/Inspector Signature: Dater—�-- �d

x Facility Number: ` — Date of Inspection 160.
Odor Issues
26- 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?
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/temperary cover?
❑ Yes 4No
❑ Yes 171 No
❑ Yes No
❑ Yes No
❑ Yes 9 No
❑ Yes OrNo
❑ Yes rMPNO
—
ona mmentwandtor*vditgs*2T1114A
�41'--5�vsz kAz CL
7TIQ
t4e� � S �,
h� "ojo
\ \ s

' [3 Division of Soil and Water Conservation - Operation Review
Division of Soil and Water Conservation Compliance Inspection
Ja Division of Water Quality - Compliance Inspection
[3 Other Agency - Operation Review
IV Routine 0 Complaint 0 Follow-up of DAVQ ins ection 0 Follow-up of DSWC review 0 Other
{ Facility Number T 2'� Z Date of Inspection12-1111-71
3'ime of Inspection
p 24 hr. (hh:mm)
Permitted [] Certified ❑ Cand�iitionally Certified 13 Registered 0 Not Operational Date Last Operated:
Farm Name
rJ t'0.
.... ........late, . ........................ Counh':.....5/lll.^...............
Owner Name:......... ............. om...... L- ....... 5.3�`Y...QU� ...�.... ................................... - Phone No:....... �f�r..���'?a...lml�.•--.4. 6i...............
Facility Contact:
............................. Title:..........
PhoneNo:.... ...............................................
flailing Address: ��.......eAttl....... -`,..t�...........I...................... .......r��kgr. 5iQxxt...N ....._.. .._ .ZVI.......
....... . .
Onsite Representative: .......... T141 ...... SUJ . If............................................... Integrator ............
Certified Operator: ....... _... i,1iW1Y\GS....... ......... 5� .................................. Operator Certification Number:...... ......................
Location of Farm:
.t-.....Y`!....�,� ....._.....6 ._.S...1.....�...o:....al��I.�S..... ef.S...... .............................................................Ll
...................................••..._........._......._..............................................................................._......__.......--....................................-......
Latitude• ®5' �•� Longitude ©•�
Design Current Design Current Design Current
Swine Capacity Population Poultry: Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I d ❑ Dairy
®Feeder to Finish Z&t o z0o ❑ Non -Layer I I JEI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish
-,.Total Design Capacity
❑ Gilts _
❑ Boars = Total SSLW � q 66
Dumber of Lagoons ID Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Ho1ciltig Ponds /Solid Traps ❑ No Liquid Waste Management System ¢Ab
Discharges & Stream Impac
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? El Yes ONo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DNVQ) ❑ Yes [�PNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dries discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes [9;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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ..... ......Z. Z...............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,a No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — T7Z Date of Inspection E-L-�,�-t-F-��
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [9 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes [1 No
9. Do any stuctures lack adequate, gauged markers with required maximum.and minimum liquid level
elevation markings? ❑ Yes 29 No
Waste Aovlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
[SNo
12.
Crop type �eyy\jt. a jrna�k- kia_ � V_ anvil Ir��
—
13.
Do the receiving crops differ with those Isignated in the Cer ified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
®3No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
M No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[UNo
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
[WNo
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
R9 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[�P]Slo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
&No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
.. Rio viptatic....- . . . . envies mere noted dix°in. ttiis:v..... .will receive r. iI i tI ... .
- corFesgondence.abauti this Visit--`
Cor>rnxents (refer to queshiin#) Ezplarn any YFS ans s udlor anyrecommendahons or any other comments f
3
Use drawings of facility to�better ex lain situations use. iddihonal a es as necess )
- 74
y�arv�� itY�c�a[1or� pom� O-J CAUiVi,\U ai�P N�1t Co,os� b� �
fir^ Z�r:\\�a.�Or\, P:� LA_ rk.ok 1�+r'rSUAr TAI �a�u� �r.l ��t(mP shag b-r tt4 ape, �
OA13Q kv NhAr` 611.k iyJo (G3c0n,
L-", SVOUII �e J�O s
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Ge_1k &Cmdtv) � sty t �t4,
Date:
3/23/99
r

Facility Number: .3 i Date of laspcction
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor below ❑ Yes RNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [RNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes j No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes IgNo
r
30. Were any major maintenance problems with the ventilation fan(s) noted? (i-e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc-) ❑ Yes 0 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
YAdditional omments an or Drawings-—..Z
A
3/23199

❑ Division of Soil and Water Conservation 0 Other Agency
53 Division of Water Quality
rQ Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of inspection
Facility Number ,
Time of Inspection LI� 24 hr. (hh:mm)
0 Registered IN Certified 0 Applied for Permit POPermitted 10 Not O erational I Date Last Operated: _
Farm Name: 1.ar...........r!'ir.................. ..... County: .......Du0a.\...................................... .......................
Owner Name: ........ -,..".m ......... 5AV.V.j........ Ir ............................................... Phone No: "" 1.�?§ �..�{rg .' atis�.
Facility Contact:
.. Title:.........
Phone No:._,.
MailingAddress: ....17D...... �sz��.....G�.�....�jn....................................................... .......... tme..IMVlk ........................................... ...zw
Onsite Representative:......... ....... Sh PA-1...:........................................ Integrator :......... C46NVW. f15...........................................................
Certified Operator; ............... k. y ...... L:............ ....... Operator Certification Number, ...... 151.4.4 ...
Location of Farm:
ov,.... sib-it......s=?........5...1......a...Q:........�nt.t�..�,..... P .....Q....:S.CZ..1.54....................................................................................
...... ...................-----............-----.--.............---............ ........
Latitude 6 64 Longitude • 4 ®«
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes (] No
b. If discharge 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 gallmin? ti Apr
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 F
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 [h No
7/25/97

Faciltty Number: 31 •-- L1 L
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[?I No
Structurg&f LggoonsHolding Ponds Flush Pits etc.
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft): ..............2 ;8.........
10.
Is seepage observed from any of the structures?
❑ Yes
JP No
11,
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
[n No
12.
Do any of the structures need maintenancelimprovement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ........................ !ir.) k.......yo'-...................................... ......---............................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
CS No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
�[ppj,,
rJ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
[9 Yes
❑ No
For Certified or Permitted Facilities Ont
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
EM Yes
❑ No
O-No.violations,or. deficiencie's.were noted -during this.visit.•You:wiEl receive-n' 616rther.,
- : • correspondence about Phis:visit.- ; . , . ' . ' , ; :.` . ..... . : . . . . . .:. ' .:. ' .... = ... , , .......: :.:::.: :
12.. C&_A-triue. c �or�{ \_v V*)p c. - 6,L. 4*Ga&.
Zz, wr4c sa ill 5�3 -661 .; bz I_J pj& c.a, j�1sco� n+✓e. S�t �1i s j C 2C ; c.
a� (kl6)u - ow sry4dl SCE
L_—'r' i 6vo 6- CLIT�icj 6 5�01 Q-101-
0.ccod r h,, to <'43 Itsh
7/25/97
Review- er/Inspector Name
Reviewer/Inspector Signature:��
Date:

..
0 Division of Soil and Water Conservation 0 Other Agency
"Division of Water Quality
JQRoutine O Complaint O Follow-up of D`t'Q inspection O Follow-up of D:SWC review O Other
Date of Inspection
Facility Number
Time of Inspection = D 24 hr. (hh:mm)
0 Registered 13 Certified 0 Applied for Permit © Permitted 10 Not O erational Date Last Operated:
c
Farm Name: ..i ...?. ..L�....r-....................................................
P
County:.... �1 p....rr►................. I ................ .
OwnerName:......... p..,ar .......................... ..V............................................
Phone No:......�.�..15..�.�.....�..b
... ...14.31{
.......
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: ....�.�y.�........ .'.tJ..i...... ..u..�.x.......�.� ....... • ,l.!_�....
Onsite Representative: .... ..psnl........ ...... iY.-._..._....._....... Integratar:.....� a-:}r...�d ............................... - Y
Certified Operator:............................................................................................................... Operator Certification Number .........................................
Location of Farm.
O.r ...S.w.. .....r..t .... ....,�.. .K-T L. r.. .. .ac�.�c z..n�.� .ct-.?.�5........w t....k$..& .......... -, .......... ....... i
........:......................... ................................................................................................ . .
Latitude Longitude =' 4
.' Design' ` Current �'Desikn Current 3 Design Current
Svvuse : _ ;Capacity Population Poultry Capacity , Populations Caftle Cal acttyPopuiahon
❑ Wean to Feeder ❑Layer ; Dairy
❑ Feeder to Finish :' ❑ Non -Layer I Non -Dairy
❑ Farrow to Wean•:,, r� . �a
❑ Farrow to Feeder ❑Other _.:.
❑ Farrow to Finish Total Design Capacity,;,
❑ Gilts a
❑ Boars �v °Tota1.SSIM
Number of Lagoons 1I-Ialdmg Pondst ❑Subsurface Drains Fresent ❑ Lagoon Area ❑Spray yield A
rea
a
r
r
` No Liyuid Waste Management System M: ,
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ElSpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in "at/min?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. is there evidence of past diwbarge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any'part of the waste management system (other than la,00ns/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
❑ Yes El No
❑ Yes R1 No
❑ Yes
ETNo
❑ Yes
KNo
❑ Yes
i4 No
❑ Yes
($ No
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes Wo
Continued on back

Facility Number: —z
8. Are there lagoons or storage ponds on site which.need to be properly closed?
[I Yes
[R No
Structures fLa oons tiol ding Ponds Flush Pits etc.
9. is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
5d No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Freeboard(ft):.......................................................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
R1 No
11. is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
V_No
12. Do any of the structures need maintenancelimprovement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
HLNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
Iallo
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type �,,�.,m.u..c�-:..............................5a,..,..`........... .... ......... ......... ................................................................................................
16. Do the receiving crops. differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [!LNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
j$ No
18.
Does the receiving crop need improvement?
f9 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
5& No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
JZNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
22.
Does record keeping need improvement?
❑ Yes
$,No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
RNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EffNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
IQ No
E•' No.violatians°or deficiencies. were noted during this:visit.- :You.will receive irti furilier
• Orres 6hdehce about this:visit:•: :
9 �'f �' '3� ..ht"; q"> Ss � '.' ', �', .ev;',E.,.' `"" F'f5,.k^ .C' "� '+b k 3M `�-. tl°,. ,�, •�' ?°AX; o*k
Camrner►ts (refer #o question #)Explainatty YE.Sanssvers andlor any recomnendtUons or any other;camments
��
Use drawings offacil�#y to betterexptatrt s,tuatonsx!(use�addittonal pages a5inecessary)���`-�� '�" "���, �` Y�
�w , -«
1 z o c w, v.J a t l t e s `, a t ty ate. i .� ,, �-�.—
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wal�l�y �-o wa,ik 0"J}4. V 1
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7/2s197
Reviewer/Inspector Name 'WRO �
F
Reviewer/Inspector Signature: Date:
A

•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: P• ` 3 D , 1995
Time: u q�f— .
Design Capacity: T_ 9,6 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 LS ° ��' Longitude: 77 f7'7' 3C" 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) 6or No Actual Freeboard: __�;?_Ft. Inches
Was any seepage observed from the Ms)? Yes Was any erosion observed? e or No
Is adequate land available for spra ?No Is the cover crop adequate? Yes 0r10h t P
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 6
or No
100 Feet from Wells? IQ or No
Is the animal waste stockpiled within 100 Feet of USGS BIue Line Stream? Yes or
is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(9
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: x 3'S—C)
Ae�_'
Inspector N me Signature
cc: Facility. Assessment Unit Use Attachments if Needed