310305_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

r/
(Type of Visit: VCom ' nce Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access II
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: lO 4 !,,, 6 �d
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Region:
Integrator:
Certification Number: f 7&,
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
n to Finish
Design C•ttsrent
Wet Poultry Capacity Pop. Cattle
I 11-ayer I Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
'Lq
7/1q
I jNon-Layer
I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current PDLCOW
Dr. P.oult . Ca aci P,o Non -Dairy
La ers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? : ❑ Yes ffNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? 0 Yes ❑ No 0 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No [_]NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
To ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued

Facili Number: 3- Date of Inspection: z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
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 []H10 �❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes g 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 EfNo ❑ 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?
I I - Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Eicessive 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
No NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N ❑ NA
jNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
ElYes
o ❑ NA
gNo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ej No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Wo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6 �rNo
- ❑ NA ❑ NE
2-T.-Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ❑ 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 Ej No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No [3 him- ❑ 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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes `Y ❑ NA [] NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
rNo
❑ NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: ���� �T Date: Z �/
Page 3 of 3 21412015

Type of Visit: &C-Ompli nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: o oQ Departure Time: �--1� County: �/1 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: g" h n f `�
Certified Operator:
Back-up Operator:
Title: Phone:
Location of Farm: Latitude:
Integrator:
Certification Number: 11 ; Z.1�1
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
an to Finish
La er
Dairy Cow
can to Feeder
TO—0
p
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C+urrent
Dry Cow
Farrow to Feeder
Dr, P,aultry
Ca achy
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
NJ
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
10
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
F:�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[2 l o
❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: jDate of Inspection: t K 7b_j
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 l l Structure 2 Z Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z7b� 2f G
Spillway?:
Designed Freeboard (in). -
Observed Freeboard (in): 3
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 EDINo ❑ 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
E:j No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 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 rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �_,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
FD�es ;�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists esign ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IJZ ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[2-No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[] No
% NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes Rio
❑ 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 (EI-No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 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 [f No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes EfNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations fuse additional panes as necessarv).
-Zo—
�q p a..
�CS`G RS Tr9� Co4—�
3 eh� k cqp
r Cc'
Reviewer/Inspector Name: 0 .t v �1 C/0 � -� (
Reviewer/Inspector Signature:
Page 3 of 3
'�jq 3SJ ?PO4(
9,e f @ l C tc,
Phone: I
Date: �� Z
21412015

�p
Type of Visit: Q Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: C3 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �11 Departure Time: 1 ,$' County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: -�TtI Lf Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: j —7
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La er Dairy Cow
can to Feeder
ZO
`ZS-�
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Design Current Dry Cow
0 , PXu-I . C►_a a_ci P,o , Non -Dairy
Layers I 113eef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
113eef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharp_es and Stream Impacts
1. Is any discharge observed from any part of the operation?
[ ] Yes
(INo
❑ 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
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
gNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: IM2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C:rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4aU404�763 64p 276y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EJINo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [ "No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes E�'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �' No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect Ian 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
[:rNo
❑ 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
ONo
❑ 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 d
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rj"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 6 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes �
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: t} - 9 Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g*f-Jo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Cn'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 [EYNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No EJINA ❑ 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
No
❑ NA
❑ NE
[:]Yes
[:(No
❑ NA
❑ NE
❑ Yes
E fNo
❑ NA
❑ NE
❑ Yes
[�J'No
❑ NA
❑ NE
[:]Yes o
❑ Yes F:�N;
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ##):"Explain any YES answers.andlor any.additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
I j q -2- Lf
pve( ] C�c
Z 71 Q O A p r /Q C r e- ►i 5
Reviewer/Inspector Name:
Rcviewer/Inspector Signature:
Page 3 of 3
Phone: IN G -;�v
Date: `7 -
2/4l2014

• Di'vi'sion of Water Quality
Facility Number � - t�J ©Division of Sail and Water Conservation
© Other Agency
Type of Visit: p Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: /1 Region:[✓ f/0
Farm Name: 7b&a I 2 TM
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: a�b 'Jid
/-4v,,
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Title:
Phone:
Integrator: ^
T
Certification Number: p Z�l
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Pou 11C.apacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
L
JNon-Layer I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Desigil
D , P,oul Ca aciNon-Dairy
ILayers I
Cow
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 21'-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes,,ETNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes Pa"No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? T
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 J:D"No
❑ Yes , allo
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑NE
Page I of 3 21412011 Continued

V
Facili Number: Date of Inspection: &P/
-
Waste Collection & Treatment
4. Is storagd capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes �No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes rii 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
0 Yes XNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes JZ
No
0 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 FeTNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [n/No [DNA ❑ NE
D 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 eoffNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes orlRo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes ETNo ❑ NA
❑ Yes ZNo ❑ NA
[:]Yes ff No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes La No
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONO
❑ 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 o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifi Number: - Date of inspection: /Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25.4s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ONo ❑ 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 4No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P!No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ;�J`No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ZrNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Off ce of emergency situations as required by the ❑ Yes. '�Na ❑ 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 PNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
9No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
.0
Reviewer/Inspector Signature: '�� �� Date: t9 ! /
/W
Page 3 of 3 214 O11

Type of Visit: ZCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: OlRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: IDeparture Time: County: Region:i%j
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: - Title:
Onsite Representative: Join ^�
Certified Operator:
Back-up Operator:
Phone:
Integrator:
Certification Number: Q`
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Design Cnrrent Design
Wet Poultry Capacity Pop. Cattle Capacity
FiLayer Dai Cow
C►urrent
Pop.
Wean to Finish
Wean to Feeder
L
I iNon-Layer I
airy Calf
Feeder to Finish
a' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
U P,o
D . P,oult , C►_a PA
PA
PA
La ers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
L
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Pouets
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes J'No 0 NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes 0 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)
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 0No ❑ NA ❑ NE
❑ Yes -ff]No ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: a Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes V No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes �ff No
'❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7r
—integrity
5. Are there any immediate threats toTthe of any of the structures observed?
❑ Yes ['�,No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
r
'
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 0 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 fallo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes � No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 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?
❑ YesNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
',0
❑ Yes /�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes es ] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VjNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes 0"No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [;"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 2- Date of Inspection:
24 •Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
'1 No
❑ NA ❑ NE
25. [s 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
WNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ -Yes
�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 5;kNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑,No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
77
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �No
❑ NA ❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
TT
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [�f`No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E;rNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes VNo
❑ 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).
Zn lecle/r s r"r dux✓
d� ire a el Ats
�� 73
0.7y
Reviewer/Inspector Name;
Reviewer/Inspector Signature:
Page 3 of 3
Phone: QlG ^�" ;..36
Date: l
21412011

_
�'Jbivrsion of Wafer Quahty.
30
Fad ty fNumlier , j O` Div>sion of Soil and Water Conservah+
n
y
ther=Agency�
Type of Visit ,C�oompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance10"I
Reason for Visit J4 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: U 0 ; eparture Time: County:
�r /Y+ Owner Email:
Phone:
Physical Address:
Facility Contact: [� Title: Phone No:
Onsite Representative: �7c��Y� 11L �►r�
Certified Operator:
Back-up Operator:
Location of Farm:
Region/z_j�
Integrator
`7f �/ 2csi
Operator Certification Number: f
Back-up Certification Number:
Latitude: o = ' = « Longitude: = c = ,
y4,'s4.S ''�y'.`'rp'F -�� '%•'a ~ T.k � - - 5 � s^.. <.. `°� i.' '�:,, ..'f...+�.'' -Current:-.' Desi n Current �, ,� ,-" Des n Current
�Swtiie .gCapactty� Population Wet -Poultry 'Capacity Populahan Cattle pCapacityPopulstion
Jk
❑Wean to Finish ❑ Layer ' ❑ Dairy Cow
❑ Wean to Feeder ' ❑ Non -Layer I ❑ DaiEy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑Farrow to Wean
D'ry Poultryx ❑ D Cow
❑ Farrow to Feeder;
xyk x:,.: Z �.y� .F °�'q �"3RY. A� "v, ,s, y"-.
'+R
' ❑ Non-Dai
❑ Farrow to Finish
El Layers
❑ Beef Stocker
El Gilts
` El Beef Feeder
❑ Boars
" ❑ Beef Brood Co
Turkeys
t e
❑Other�Numberof
Structures. r
El Non -Lavers
El Pullets '
❑
El Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [3 Structure ❑ Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P3 Na ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes �NO
❑ Yes �Q No
❑ NA
❑ NE
❑ Yes PKo
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facili N mber: - Date of inspection: Z
24, Did the facility fail to calibrate waste application equipment as required by the perm' ? ❑ Yes P1,110
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes '[�No
the appropriate box(es) below. TT
❑ 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 Pilo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 'C�`No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes P,No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
'
No
29. At the time of the inspection did the facility pose an odor or air quality concern?
[-]Yes
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes �,}�No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ;] No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �TNo
TrLo
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional oases as necessarv).
(sL 0*041W Q.5 e 3/1!/! Z rJ�.g a nal� SITS
11 m �
/ zr
6y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: — 7
Date:
2/4 11

Facility Number: - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Pi No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
fiNo
g"
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
allo
❑ 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
JZ 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 /En No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P?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 �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �kNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 s ❑ 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 10 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes )allo
❑ 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 ;D-No
❑ 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 IZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes �0 No
❑ NA
❑ NE
the appropriate box.
[]WUP El Checklists 0Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ,Ej Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard P4aste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'E�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IType of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 55i&J Arrival Time: ` OP eparture Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: -ASL,%-.Or
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator
Operator Ce ' ication Number:
Back-up Certification Number:
Region: (��
Latitude: = o = = if Longitude: 0 ° = g 0 «
Design Current
Design Current Design
Current
Swine Capacity Population
Wet Poultry
Capacity Population C►attle C•apaeity
Population
❑ Wean to Finish
[[]Layer I
I ❑ Daia Cow
❑ Wean to Feeder
I JE1 Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ farrow to Wean Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts ❑ Non-ts ers
El Beef Feeder
❑ Boars El Pullets
ElBeef Brood Cowl
I
El Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Numiber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes Rio ❑ NA ❑ NE
❑ Yes FrNo ❑ NA ❑ NE
❑ Yes [1 No ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes No ❑ NA JDNE
12128104 Conlin

Facility Number: c7" d Date of Inspection
Re. wired ecords & 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 ETNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [3 Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes '[,_,�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
-F-1-No
❑ NA
❑ NE
❑ Yes r—
El NA
El NE
❑ Yes
EMo
❑ NA
❑ NE
❑ Yes
F o
❑ NA
❑ NE
❑ Yes
'p'No
❑ NA
❑ NE
❑ Yes
O—No
❑ NA
❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes P ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
�l
l
�/y�
(Y1lJS/� ��c� 2 Z
A,
C5 Z.
' CCorG'S �L �C a
Page 3 of 3 12,128104

Fgc><hty :Nurnber
tp
p
%Division of Water Quality. :
:Division of Soil and* -Water Conservation
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit _Q-Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I /V.C�Departure Time: County: Region:
Farm Name: rf- a Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 =As Longitude: = o = g = is
JA
,r
-
Design 'Curren#r" Destgn Current Destgo Current
Swine
Capacrt} Poliulahon Wet Poultry Capacity`'P,opitlation
C
Cattle apacrty
Population "
❑ La er
v ❑ Da' Cow
❑ Non -Layer
m ❑ DairyCalf
.,�
❑ DairyHeifer
❑ D Cow
Dry Poultry,
Non -Dairy
t
❑ Beef Stocker
❑ Beef Feeder
q El Beef Brood Cowl
--�—
Am
-�Turkey.
Other
k;
o Struct
Nu ur
robe f
e.L.:
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Poults
❑ Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes FMo ❑ NA ❑ NE
El Yes El No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Zf`No ❑ NA ❑ NE
El Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 12/28/04 Continued

Faciiit -Number: — Date of Inspection
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: �-
Spillway?:
Designed Freeboard (in): 276
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or manLaged
through a waste management or closure plan?
❑ Yes fiTNo
❑ Yes PNo
Structure 5
❑ Yes
❑ Yes
❑ NA ❑ NE
❑NA ❑NE
Structure 6
❑ NA ❑ NE
❑NA El 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
XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ 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 VN. ❑ NA ❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ INo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo. ElNA ElNE
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 7 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes pNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes O No
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers, and/or any -recommendations or any other comments
Dse drawings of facility to better explain situations. (use additionaUpages m necsa esry) - �
.,
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: ,S
Page 2 of 3 I21AI04 - Continued

Facility Number: — Date of Inspection (J
'Reguire_d Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;a'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �,ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes oNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �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 FerNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes Zo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ;XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
,�,/
❑Yes FzK
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �No
El NA
El 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 Id 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 [ 4
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes F_Wo
❑ NA
❑ NE
Additional C©mments andlor. Drawings:
Page 3 of 3 I2/2VO4

Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine () Complaint O Follow up O Referral () Emergency O Other ❑ Denied Access
Date of Visit: / Arrival Time: %QQ Departure Time: County:
Farm Name: A/ &/'crt f Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact:. ` J Title: yyPhone No:
Onsite Representative: _15A V Integrator: nZ16
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = e = 6 Longitude: = ° [� ` = "
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Cattle
Design
Capacity
Current
Population
❑ Wean to Finish 10 Layer
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
I ILI Non -Layer I I
❑ Feeder to Finish
Dry PoulEr.}
❑ Layers
❑Non -La Non -Layers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Pullets
❑ Boars Turke s
❑
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ExNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
Cl NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�dNo
❑ NA
❑ NE
12128104 Continued

Facility Dumber:3 —,3
3U Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JSNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes RNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -32
5. Are there any immediate threats to the integrity of any of the structures observed? ElYes
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
JONo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
gNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
VNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
XNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
JZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
'
Comments refer to question # • Explain any YES answers and/or a � ( q ). p 'any recommendations or any other,comments . - V a
Use drawings of facility -to better explain situations. (use additional pages as necessary;)
�`e Co
Reviewer/Inspector Name I / I GV/-, f &-ef Za : . ; , Phone: /G
Reviewerllnspector Signature - Date:
12/28/04 Continued

Facility Number: 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 [Z'No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P(No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
7No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ 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
XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
'VNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments andlor Drawings:
1 /V
AL
12/28/04

Type of visit 9) Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine A Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: MW Arrival Time: F/9— 6d Departure Time: County: t:I Region:
Farm Name: AVJy­1 Owner Email:
Owner Name: C)L_% u ECZ aI Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Title:
Phone No:
Integrator•
Operator Certification Number:
Sack -up Certification Number:
Latitude: = 0 0 ` " Longitude: = o = ` = "
Design Current
Design Current Design Current
Swine C*apacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
® Wean to Feeder
CD
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry ❑ D Cow
❑ Non-DaiEy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Seef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
O#her
❑ Turkey Pouets
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes q No ❑ NA ❑ NE
[I Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
El Yes
No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
P�No
❑ NA
❑ NE
12128104 Continued

Facility Number
Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit © Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine ¢Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S%(3!� I Arrival Time: Departure Time: County: IAI Region:
Farm Name: ��y i— tZ n���`` Owner Email:
Owner Name: ��C-1 U �L_.l 1 L �lL Phone: f
- - 1
t - ,
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = I = t[ Longitude: [� ° = i = i1
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer S POD ❑ Non -Layer
❑ Wean to Finish
® Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
El Pullets
❑ Turkeys
El Turkey Poults
❑ Other
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 1ANo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NAi
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ yes {©No,
El NA
El NE
❑ Yes Q,No
❑ NA'_.
❑ NE,
12128104
Continued

Facility.Number: 3 —'� Date of Inspection lot 5 01C
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 ONE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes
'" 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
bn No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
IM 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
[RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
® NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ElNo
ElNA
NE:
�rAi TO �Z.RC.0 16 H 7+1CIF
t~t-J c' "),
CO3N7007 �-
W+r�
Reviewer/Inspector Name '1rn O'� C`r ;� 1 N -,q xr r is N E~ C L _ Phone:
Reviewerllnspector Signature: r trj w-ka`t-i -AgLmQ T Date:
Page 2 of 3 12128104 Continued

. f
Facility Number: -- . Date of Inspection 0
Re uired 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 bNE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �RNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Main Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
`4 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
V,NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
WNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[ONE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
JONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
�Q 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 concerts?
❑ Yes
❑ No
❑ NA
4NE
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
WNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
KNE
Additional Comments and/or Drawings:. ;
SNP STIA76b j 44 i ta-n_G-9L wA S A lt� t W R LflaC'C AMC)LkN j
R 1 1 f�Ct NoG: �f�QM �Jv J�ou a�[, Dco g a-`TNCAI FaCZ �-�3 DRAS
- c�� �tZ a � I ��► l � 8 >r+o � W ASH w0S Q p />v� PA pikpE
SH£ S-fpT�� iH£ o�� WAS COLLV /Ci HCZ 10 P&F- S )CK
�T WA CITT/NG" 1 N TO CLr� i }� 514e NU/Vl oc cT
TI-APaVE�� aP �)rnANDA Rolj�E Cr_t ; 7-0 T-HE s1 TF -t PCWN6
Ilia E0,'01�! Ne� T44P F T44E wA S7 wAs Ai)�XA �As tN c o MCCT(_k� <*
-MFV i I�r 1/Vbl L31bU4L mflktuc 1-HE_CdA4D(A,
k_k�pvS cox/7 4C 1 E -i-- !X F0ZAkE) OF!
Y,CU tN 2ow4RN� CON TA-cTGb - <h ccwCPL- 4 L-G T THEnk x A/Ot T.q E
NATLkV_C of -1*9 c Dm?U�/Al i -1 T14y- 1 AID I/V j.,qS
Page 3 of 3 12128104 .

Facility Number: -- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
❑ Yes ❑ No ❑ NA � NE
❑ Yes ❑ No ❑ NA 6NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA RNE
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25, Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) ce! ification?
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? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
❑ NA
✓�NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
Ej NE
❑ Yes
❑ No
❑ NA
[if NE
❑ Yes
❑ No
❑ NA
] NE
❑ Yes
❑ No
❑ N,�'`YjTj,NE
❑ Yes
❑ No
1'
❑ NA
a
NE
i
❑ Yes
❑ No
❑ NA
9NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
❑ NA
q1 E
❑ Yes
❑ No
❑ NA
5LNE
�/V C /v ;
a 7 j H r_ F136 Prti i C)/Vd u cl, CYJ i N C A/ v4Z c; - ASS
ANC wNOC WAsiOS P2,r//VC,' Pc,�,�t
5NF 7 ��� 714 CZ0 w7s C.i-)UC/n/C F1 `il. ICE �E. � L SIC K
CA lJi W1S GE`TTIAIr /,V To LCT) SHr PC iNK)_CU 70 \0
pk)N Ti1V_XiCL.L �m►�N7l-� �a t.vL- S 1�ZobE GLA i To i frC 5/ 7 r y GCS inl�
/VO Ui_ NCB -i € P i -WIC L�q a7 Uv�lS l' -I C 1N C v �t C. r LL�
T F�C� Wad nNIVIO-10c ) w //v) juj ��L i`Ylr)'<lA1r 141C CaA.1r'XAI
C-)XITAC! -4 1/Y(A�2 � 1/Vb//1)(C.
K` UIN 1CowAN1� CUX17r� C i s i Q Cx�vtl[ y L J Fly- t�� K I�/GW `] f1 t
N�iu2E o� iNt; cr�n� Al�t1 i `-t TOE r /AID//vC_,S
Page 3 of 3 12128104

v
a
0 Division of Water Quality
Facility Number ` 3Q 0 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 Emergency 0 Other ❑ Denied Access
Date of Visit: 6 Arrival Time: .� Departure Time: County: t Y*- Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: =] o =]' 0 Longitude: [=° 0 i=
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑_Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other
❑ Laver
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Cprren(:r
Capacity Population'..'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes 2 No_ ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes )ffNo
❑ Yes
1No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El NA ❑ NE
a. If yes, is waste level into the structural freeboard? El�Zo Yes ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): = toz.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
�3 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
dNo ❑ 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
dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
E2,�ko ❑ 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 El NA El NE
maintenance or improvement?
`
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El,�J Yes
,_,(
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
0No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
ace /-/— r;2 0GvH
Reviewer/Inspector Name f Phone:
Reviewer/Inspector Signature: Date: �/ g
Page 2 of 3 12128104 Continued

• 'J 'Factity Number- ?)Z31ff Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYesV ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
�(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�fNo
❑ 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
dNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑
❑ 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
�p
Additional Comments;and/er Drawmgs -a A�
AL
1,7
3/,108
1�
Ay��
f= y
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visitoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: r d Departure Time: County: l� Region: ��
Farm Name: �dc� !�l/�/%� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 11Title:
�',1
Onsite Representative: N 1ft��) J �0 — -:30 7.Z
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No•
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0 g Longitude: =° 0 t
Design Current
Design Current Design C►urrent
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder 00 lao
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets
❑Beef Feeder
❑ Beef Brood Cow
❑ Boars
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
O-No
❑ Yes
Po
❑ NA
❑ NE
❑ Yes
p4o
❑ NA
❑ NE
12128104 Continued

Facility, Number: 3 0 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 Struc2 Structure 3 Structure 4
Identifier: •�—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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
❑ Yes ❑ No
Structure 5
El NA El NE
El NA ❑NE
Structure 6
❑ Yes []-No ❑ NA ❑ NE
❑ Yes C'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑.No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ?-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area f
12. Crop type(s) bfn I S Q i �,J� M
I ) I i, MI, Cyw\v.x(I S( kw P 1 i Oar C (O
13. Soil type(s) �,L, �� � i d I ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .ETNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ffNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes El —No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [I -No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes _3"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):.
Was ate' 1�wl-5 ufttfr sew
5' y
Reviewer/Inspector Name �� �r Phone: U— "% 6/�
Reviewer/Inspector Signature: Date:
Pare 2 of 12128101 Continued

Facftity Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E3,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .0 No ❑ NA ❑ NE
the appropriate box. ❑ AIUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
E 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
.ETNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ENo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EI'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
[j 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
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
(PNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P"No
❑ NA
❑ NE
Additional Comments and/or Drawings:
H,
Page 3 of 3 12128104

x Db&is n of Water
tVlSwn of Soil=arid Vf�ates Conservation
GVLEEeP Ag@IICyt
Type of Visit CAS Co fiance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number S Date of Visit: 7 4 Time:
Q Not O erational Q Below Threshold
Ef"Permitted Certified © Conditionally Certified 0 Registered Date Last Operated or Abov Threshold: ... _.. _. ..
FarmName: ....._._ .,�................_._ ........-................__,. County: ......»..........».. _. �..._...» .
OwnerName :....... ...................... _.......... ..._................ ............ ............... .......... _ _. _..._.. -Phone No: ... ...............
_.... ..__............. _.........._.._. .
MailingAddress: .... . ......................................... ..._ .... ,_,._ ................._ _ .... _. ._ _.._W...... W_
Facility Contact: ..__......._.—.......................................... __ Title:. _ _. _ .. - - ........_........_...._ _ . Phone No: _ .................
Onsite Representative: �^ ,1
..'J-ow ._.-..._..�......��-----_.._._................................ Integrator -
Certified Operator :................__ ._....._ .. _..._ ..__._........ Operator Certification Number: ..
Location of Farm:
.,
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ram• 9 66 Longitude �• �6 94
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 6�xo
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 gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Q No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... ]�. - _...... }' ... _............. --._,...-.... ......... ........................ . ....... _
Freeboard (inches): 3�
12112103 Continued

FacilityNumber: 3 — 3 05 Date of Inspection11 i !
-�F
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes 7No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes zria
S. 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 maintenancefimprovement? ❑ Yes N
11. is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [ 1�To
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type pip CSw
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes o
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ZNo
liquid level of lagoon or storage pond with no agitation? /
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,4—�,�'C"•
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 o
Air Quality representative immediately.
Commits (refer torqueshoa #) 1 airy YES saswers aaalor any r�ommendation or any oth"er comments: '. a
;Use drawn of faced to better laen situsteons. (use.addeteonai es as necessary a
h' F e i- P } Field Copy ❑ Final Notes ,'-
. �
P ecp To uflwrt WVP To FuT NEB RESWC FseLD lj� AND to CALL tAT(=�
poa s '8q AW,5.
5 HAS'
Reviewer/Iospector Name --
.7�HSAv
Reviewer/Inspector Signature: Date: -->I 1 L64
12112103 j Continued

Facility Number: 31 _ 30.5 Date of Inspection J I
L
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes Q N
23. Does record keeping need improvement? If yes, check the appropriate box below. ElYes To
❑ 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 1:540
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ,Invo
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
28. Does facility require a follow-up visit by same agency? ❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes FNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit 1SLCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit & Routine O Complaint (:) Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: Z Time:
S
Not Olperational Below Threshold
S.Permitted [aCertified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Y`f/ I11I _ County: � O7/1ItiIf
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: 77A h jjr Integrator:✓/7ft9'e
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0" Longitude ' Dy
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ 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 E'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P-No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Apo z
Freeboard (inches): 3P
05103101 Continued

Facility Number: — p
Date of Inspection Z1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes K311-0
❑ Yes O o
❑ Yes Eallo
❑ Yes RNo
❑ Yes �No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes HTNo
11. Is there evidenceofover application? El Excessive Ponding ❑ PAN ❑ Hydraulic Overload❑ Yes [}'l�o
12. Crop type--/-tjre 4,1-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 93-No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [9'90-
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 moo'
16. Is there a lack of adequate waste application equipment? ❑ Yes 99-NO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes E3,�To
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? , ,,
(ie/ WUP, checklists, design, maps, etc.) ❑ Eg Yes o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) E2'1'es ❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes M-ro
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [ZK
23_ Did Reviewerlinspector fail to discuss review/inspection with on -site representative? ❑ Yes
GJKo-
24. Does facility require a follow-up visit by same agency? ❑ Yes 0lq0-
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [}l0
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
y;T
Cnmiteents (refer is quektiun #) EiplaW`an' y YES answe�s7a' i any reco;_ mme_©datzons or auv nthes comments:
:Use drawings of farilrtv to better eiplarnsit inti6�:'(use additional! pages as n�ecess'ary) El Field Cot�v [I Final Notes l
- _
"/iolao,,wl
e J �
-'/¢ew a. Z007- soi/ Se4,.y�/� 4"- 4"D�M.
— lPed -�v J-ee # tA �/c oT klms fG st,•,,,o/ L�r/G°.,�.
,%1-�/�►c
Z �-ar rrs� e 6vrYng ��'� Sa�n�4 �Zp4/,� l�P/L lr��w
�lek P��-tb,- 2�vz s�
Reviewerlinspector Name
Reviewer/inspector Signature: Date: 6Z
05103101 .10,
Continued

Facility lumber: 31 — Date of Insluction ` 7
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 [E . o
❑ Yes ®h'b
❑ Yes D�b
❑ Yes o
❑ Yes [�Mo
❑ Yes Ao
❑ Yes No
and/or Drawings: _a •A ttiona : am€nenis- .
i
05103101

Dvnsron of Water Quality_
} Q Division of Sort andtWater;,Conservatton
x O n
Agency t � `' � ,�• �' � �� �
Other _
k �
Type of Visit XCompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit ;0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
I)ate ofVisit: 3 2 al Time: 16' Printed on: 7/21/2000
31 aS
rQtot Operational O Below Threshold
Permitted [3 Certified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .....................
Farm Name: '-^ .. .....V f.l''�........................................................
....ar.................................................................................. County
Owner Name: ('7 ✓e1' a"+I a `V Phone No: .......................................... ............................................
.............................. .................
Facility Contact: ............
Mailing Address:.__..,__,,.
Onsite Representative:.
Certified Operator:,.,,,_._,
Location of Farm:
7-6LI n 467.rd....
Title:
: Phone No:
..................................................................................... ..........................
_..., Integrator..) ...yv ^��`
.......................................................
......................... Operator Certification Number:.... .......... ............. ...............
[]Swine []Poultry []Cattle []Horse Latitude Longitude •
Design Current
Swine Canacitv Ponulation
Wean to Feeder
SZDp
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lag -on Area ❑Spray Field Area
Holding Ponds / Solid Traps j IF] No Liquid Waste iNlanagement System .
Discharges & Stream Im acts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a: If discharge is observed; was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/ruin"
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 & ,rreatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Struc;turc I Structure 2 Structure -
Identifier: ..............I ......................................................................
Freeboard (inches): 46 3D
5100
❑ Yes A f No
❑ Yes .1@"No
❑ Yes 49 No
n kt
❑ Yes � No
❑ Yes f'No
❑ Yes ,TNo
❑ Spillway ❑ Yes WNo
Structure 4 Structure 5 Structure 6
Continued on back

Facility Number: 3 I — Date of Inspection 2 d1 Printed on: 7/21/2000
5. Are there'any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes .KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes DdNo
(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 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes `� No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ;ffNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic
Overload ❑ Yes J] No
12. Crop type Co e rt jilt'1,4,r An v ' E4--xS .i gKfa ✓Z !` C ,—Ell ¢r-0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 10No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes V1 No
c) This facility is pended for a wettable acre determination? ❑ Yes A No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes ,4No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
+�j1 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JZ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
"FilNo
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
ElYes
06No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
j No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
:: �'�10 yiolati6iis'or• deficiencies .*i6re hotted• diWiiig this'visit. - Y:oi>E Wiil-i-eceiye too furthe' r' - : -' -
corres otiden'e: ab' f this visit: _ _
icamments (refer to question#): -Explain any. YES answers and/or any recommendation o ariy other comments ti t M x
Use drawings of facility to better explain situations: (use additional pages as necessary} . , -
ctvtd ,-ecor,ds ctee wej1 kefi� Crafos a''e t✓elt e,571411'Aga A'
9r
Reviewer/Inspector Name 4 "_c.tn.•t
Reviewer/Inspector Signature: Date: .7 Z-9 0/ 5/00

Facility Number: 3 t —3D5 Date of luspection Printed on: 7/21/2000
Odor Issues
• 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge �t/or below ❑ Yes )dNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'P No
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 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) []Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings:
S/00

Dlivisidn to Water Quality
�; k
Q Dkston of Soil and Water Conservation n
a
Type of Visit R Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (Y Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number [)ate of Visit: I I/ DO a 1 Tirne: 1 /3 d Printed on: 7/21/2000
Q Not Operational Q Below Threshold
A
ermitted Certified Conditionally Certified [3Registered Date Last Opera. • -..t ibove Threshold : ......... ...........
� Y
Farm Name:............�-,�..............................1:....lA................................................................ Count':..-.Itinti_ .........
o
OwnerName:.......................j......................................._.:....................._.................................... Phone No:....................................................................................... y
Facility Contact: ........1] 1(lc. ..........
�
... .L t: .......Title: ..-.. ....................... Phone No: z;�.. -7S-4,(
cr Ju�......--••-
MailingAddress: ................................................................................ ... .......
Onsite Representative:.,p..k,."..g.L/-Y.-"�c -............... .... - . -. ....... Integrator :.--•---. -
Certified Operator:. ........ Operator Certification Numb r:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 1�J' �� �'� Longitude �• C`°°
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder svo ❑ Layer 10 Dairy
❑ Feeder to Finish 10 Non -Layer I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag--n Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes O(No
Discharge originated at: ❑ L goon []SprayField ❑ Other \
a. If discharge is observed, vas the conveyanec ratan-rnadc'' ❑Yes ❑ Na
b. If discharge is observed. did it reach Water of the State'! (if yes, notify DWQ) [3 Yes ❑ No
c. II' dischan.,c is observed. what is the estimated flow in gallmin? J A —
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? El Yes jk`No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [�Ivo
Waste Collection & Treatment \\
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
StrUGturc I Structure 2 Struc:ture 3 Structure 4 Structure 5 Structure 6
Identifier rt
11........... .......... g...-.-..............-...-....-....-..................................... ...-.....---- .-...-•:............................ ........... ..
Freeboard (inches):
5100 Continued an back

Facility Number: 27 1— d Date of Inspection d Printed on: 7/21/2000
5.. Are tfitre any imrAediate threats to the integrity of any of the structures obs rued? (ie/ trees, severe erosion, ❑ Yes N0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes o
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancermprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence o ver a!f.
cation? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload
12. Crop type 1l 11��j
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21 _ Did the facility fail to have a actively certified operator in charge?
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ 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?
0: INo Molaitoris:oir. deficientkwere ngted, d irring this:visit; • Y'ou will •reeeive lio Furth& • : - : -
corresnondeirce: abotati tits :visit:: ::: :: ::::::.::::
❑ Yes klo
❑ Yes Ir0
❑ Yes Cr0
❑ Yes [�No
El Yes ' \�No
❑ Yes Wo
❑ Yes R�No
❑ Yes No
❑ Yes j No
❑ Yes f �11 No.
❑ Yes �` No
❑ Yes A No
❑ Yes
[ No
❑ Yes
\\ o
❑ Yes
No
El Yes
o
❑ Yes
qNo
❑ Yes
ro
ElYes]
No
❑ Yes
1111N0
Continents (refer to question 4): 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):
4114- /a 6A.(
X "--I.X -1-7 („^opt 4 c �. Z ZW -2— `Tv r",s .
7416P Pletisf rmAe y. JaW /; S a// hy�/�-��f 5 w� 72iO'� �� S
sine yo-pt alv<_ 14!�4 ­1 {GAOL,/
Reviewer/Inspector Name
Reviewer/Inspector Signature: l
Date: %
5/00

Facility Number: — Date of Inspection 1l i GJ Printed on.• 7/21/2000
Odor Issues
• 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AJor below ❑ Yes No'
liquid level of Iagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes r 0
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 KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Imo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNo
AdditionaMornments and/or �DPeI..wi�✓�� TZcMnav���l�
Vf 'N,t orooL InGv�e��-E
Ct", 1 1
J
5100

i 0 Division of Soil and>Water'Consecvaon Uperataon Review
x Division of Soil and Water'Conseiat�ou `Compliance Inspection t r ` f
nice pection Division of Water Quality F CompliaIns=
E3 Other Agency,' Operation Revtevv
IQ Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other �
Facility Number l Q Date of Inspection Time of Inspection f3 : d O 24 hr. (hh:mm)
0 Permitted 4Certified © Conditionally Certified 13 Registered 113 Not Opera Date Last Operated:
Farm Name: ....... S....... ' ....0.......e-1.a.:l.%........................................................... County: .........�D, -Q-P .1. t 7._..................................
Owner Name:.........1.1.Y..-....4.t?.�`1Q;L'............................................................. Phone No: ...... .1.Q.....�..�.T.....................
Facility Contact: .......... ....... VH ate} .................... Title:........ ............................ Phone No:17/
ZY. 5 —7 .Q..
Mailing address: ..../..714...... �4��5.....L —ml, �....,I1.d.............................. ................................ Z�.�..�..$
Onsite Representative: ............................ .... Integrator:..........U�.l'.1 ............................... .........
........................................................................... .. ` ......
Certified Operator:..,.,,.,.... �..ab.n.........I, }l ..4 ....... ,. Operator Certification Number: ! r (, v . ............
Location of Farm:
.......................................................................................................................................................................................................................................................................... ]
Latitude • 1 1 Longitude 0 ` "
Design Current. Design'• Current Design Current
Swine Ca Capacity Po ulation Poultry Capacity. Population .Cattle Ca acity Populatton ='
® Wean to Feeder zC0 ❑ Layer ❑ Dairy
❑ Feeder to Finish JE1 Non -Layer ]E] Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars •Total-SSLW
�N+utuber nf.Lagoons : ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdin ' Ponds / Solid•Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
j] No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -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 gallmin?
A-
d. Dues discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
j No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
f�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
14No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
*o
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
yy nn //��f�
Freeboard (inches): .............. .i....l...........I.............�l...l................ ................................................
...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
34
seepage, etc.)
3/23/99
Continued on back

Facility Number: 31 — Date of Inspection
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
f. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
1)10. , iolatioris;oi' deficiencies mere jnoted. - hitting Ois:visit: • Y:ott'ivfll-keceiye id futtUe - :.: -
corres oridence:ab'a'fthis:visit. :::::::::..... .:•:-: ...............................
❑ Yes 6(No
❑ Yes allo
❑ Yes `VNo
❑ Yes *0
❑ Yes iNo
❑ Yes ) ] No
❑ Yes dNo
❑ Yes No
❑ Yes [XNo
❑ Yes ❑ No
❑ Yes qNo
[:]Yes 13�_qo
[]Yes 2YNo
❑ Yes M No
❑ Yes [YNo
❑ Yes [(No
❑ Yes Q1�40
❑ Yes [No
❑ Yes [)�No
❑ Yes WNo
❑ Yes Rio
Comftients {refer to question #) Explain any YESanswers and/or aayrecomi iendations or any other'coimments:
Use drawings of -facility to_better:"explain sihiations •(use addiRonal,pages as -necessary) =_
l I=!!: 1 {
M(. oiALLi 6 s- n }- CLFel f e-toy Pc m t � a. Z ti i i I i v14vt r{� "J
aA kj e-4- 6&c_ k -i-o h ,n'L - 1 Y
#a ro_ rm t s wtil a eL /i) e1,e. i
Xce j� ec4c v4 •o ri i
All �arr�c �rd�'is We-sle- Fiat -e— �0�'1 las-l- (ea.✓S t,1SP&,4an
w
Reviewer/Inspector Name }
Reviewer/Inspector Signature: Date:
3/23/99

Facility Number: —'z15 Date of Inspection fZ
Odor Issues
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )Rj No
28. 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) `
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? Cl Yes r10
J32--Do the Bush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
A:dditi-onal Coxrimnts an .or." rawin ._
3/23199

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
tRRoutine 0 Complaint 0 Follow-up (if DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection (0 0
' Time of Inspect ion `. 24 hr. (hh:mm)
U Registered gCertified U Applied for Permit 0 Permitted 113 Not Operational Date Last Operated: ..........................
FarmName: ................... � Q.... F... r........................... ............................................................ County:........4b.!.........................................................
OwnerName: ................ 01.1Y................ ....... QvkL:............................................... Phone No:....��LO )Z.g.3....� �...........................................
Facility Contact: ........... -14LX1.......:..... N.r.d ........................ Title:................................................................ Phone No:.....L�..1Q 33c.Z�.6.�..........
Mailing Address: ........ :%.(4.......... 1&OA4S.....Rj— ............................... ......... WrrxSR(.)... i._4...................................... .. aA.......
OnsiteRepresentative: ........... SQ h...... �rfl.....[....o i�!.W...- ................ Integrator: .......... NL!J............................................................
Certified Operator" ........................................ P....................................................................... Operator Certification Number .........................................
Location of Farm:
........... an.....56............�..e..:.2.......... P,._l. flo.r �. Z..trs...g....P.txS'.......a.........13,.1.:.1.............................................................................................
.......................................... ............................................ .......................................... ............................................................................................................... ............................
Latitude Longitude
Design_, -,,Current;_,-. Design I Current Design'- Current.°
Swine . Capacity Population -Poultry' ' -Capacity ;Populatioq Cattle„ Capacity ;Population
Wean to Feeder - 5700 ❑ Layer 1 10 Dair
y
Feeder to Finish ILI Non -Layer IFA ❑ Non -Dairy
❑ Farrow to Wean -
J':; ElFarrow to Feeder ' ❑Other -
❑ Farrow to Finish Total Design Capacity.
❑Gilts
❑Boars °Total SSLW<'-
Number iif higooris / Holdmg Ponds 0 Subsurface Drains Present ❑ Lagoon Area Spray Field Area
n r •' ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify, DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
A ►:
III was 1-5 M.
❑ Yes 0 No
❑ Yes No
isT
❑ Yes P
No
❑ Yes PNo
❑ Yes qNo
❑ Yes i No
❑ Yes 0 No
❑ Yes ® No
Continued on back

Facility Number: 3%
. Are tlTere lagoons or storage ponds on site which need to be properly closed?
Structures ll,agoons,flolding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ? Structure 3 Structure 4 Structure 5
Identifier:
.............. ,,..I.................. ................................................................................................... .............................
Freeboard tft): ........... 2? T...... .................3-.7..........
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes ® No
❑ Yes 0 No
Structure 6
❑ Yes RINo
❑ Yes �3No
12. Do any of the structures need maintenance/improvement? M 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'
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....... C Q(n.........._ t^ ....W u.� ........S sAt,- :................. .SC t%c....................:.......:.................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application.?
18. Does the receiving crop need improvement?
I9. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
0 No violations otr deficiencies. were noted -during this:visit.- .You will receive no further
correspondence ii4out this. visit.- :
❑ Yes [P No
❑ Yes 1P No
❑ Yes [ANo
❑ Yes '�j No
01Yes ❑ No
❑ Yes 0 No
❑ Yes � No
❑ Yes P No
9 Yes ❑ No
❑ Yes � No
❑ Yes No
❑ Yes No
Comtnents'(refer to question #) Explain any, VES' answers and/or any recommendattons or any'other comments
Use drawings of ractltty"to better'explair situations (use,additiotial pages
as necessan)
ti
W�
J
-Y+- �4�- "Ct3UWS
ih Ct,tI, 1�.
tt
(��-Z. + rh. Should �e_ y
� r 0,4
1 f
k _, +_ k)N_.
k;r.— 4-ccc,A %.
OA-
7/25/97
qV
Reviewer/Inspector Name
Reviewer/Inspector Signature:
_ Date: C O

•
•
Site Requires Immediate Attention:
Facility No.r
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ¢ 1995
Time:_ '
Farm Name/Owner:
Mailing Address:
County: _ L
Integrator: 0
'M•
IU or -
On Site Representative: C21t V Q r { J Jf t AAJ _ Phone: WI U Z?l �? l .;:5 - fy
Physical Address/Location: _ &¢ ,74-52uv, :5f_ 1300 , fh_Gry53/'s5
%-..Z M
Type of Operation: Swine -kf'—" Poultry Cattle IU(}r5E>,r.{�
Design Ca Z r f Animals on Site:
Capacity: ty. _ _ _ Number •
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �J� ' 6�0 ' _41_43 Longitude: :27 ' � 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) CeDsbr No Actual Freeboard: (a Ft. C7 Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Ye or No Is the cover crop adequate? Ye r No
Crop(s) being utilized:. (2 h'r1
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes a No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or io
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o ONO 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 r No
Additional Comments:
L_- LAWs -
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

}
DSW.GA.,_Animal Feedlot Der a"ton ArRev�ew
> f Date ;of _in.-spectionf, imeof inspection
�Facili y Number s N
Use
Farm Status; _ 1c_! ,. _ .. Routine ❑ Complaint 0 Follow-u
Farm Name: t� _Sll�� ,� County:._....
Owner Name:Phone No:
Mailing Address: W k/r-/? 2a5 _��LrSGF' Z
Onsite representative:-A,-)li) 0!,r .. integrator:
Certified Operator Name: a I
Location of Farm: -
Latitude �• 4U '�" Longitude `%� • ©�
❑ Not O erational Date Last Operated:
of Uperation and Design Capacity
Feeder to Finish
Other Type of Livestock
,Nttm er afagoonsc�{�,Ha€dir<g<PondsY 'L .��� Subsurface Dratns Present ���'r
�. ❑Lagoon Area Spray !Field Area
General
1. Are there any buffers that need maintenancermprovement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
® No
a. If discharge is observed, was the conveyance. man-made?
❑ Yes
® Na
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
®No
c. If discharge is observed, what is the estimated flow in gavmin?
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
® No
4. Was there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
(9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
.0 No
maintenance/improvement?
Continued on back

s 6. Is facility not in compliance with any applicable setback criteria? ❑ Yes 10 No
i
i; 7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)? ❑ Yes (4 Na
i
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes." [9No
Structures (Laoons and/or Holding Ponds
9. Is structural freeboard less than adequate? ❑ Yes CgNo
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. is erosion, or any other threats to the integrity of any of the structures observed? [3 Yes ® No
12. Do any of the structures need maintenance, -improvement? ® Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWO)
13.
Do any of the structures lack adquate markers to identify start and stop pumping levels?
❑ 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 DWG)
15.
Crop type
16.
Do the active crops differ with those designated in the Animal Waste Management Plan?
❑ Yes ,-91 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the cover crop need improvement?
❑ Yes
® No
19.
Is there a lack of available irrigation equipment?
❑ Yes
JR No
For
Certified Facilities Only
20.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
,0 Yes
R No
21.
Does the facility fail to comply with the Animal Waste Management Plan in any way?
❑ Yes
®No
22.
Does record keeping need improvement?
❑ Yes{
No
23.
Does facility require a follow-up visit by same agency?
❑ Yes
&I No
24.
Did Reviewer/Inspector fail to discuss reviewlinspection with owner or operator in charge?
❑ Yes
0 No
e
V.
5.
r5
'fit; :_,x,a�°'�. �a e;^S,.- itaa�.- °�• x�.,�SS'�'.••;
fie.viewerflnspector Narr�e«k WX«vu+ t i uyt yt y�
r;.r^�.,,.�{,.-�,.�1,?`.�, 'a .;; 41� a�.,.s �..x..s .,.-s'-c^w'�€?.,� �r^��,�. .t � � � .��•"�" �r �, �L' � �=�"'drti ':�
Revewer/lrsspec#orSignature
• t
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96