310306_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

0
Division of Water Resources
Facility Nttrttber 3 - .3 0.6 © Division of Soil and Water Conservation
Q Other Agency
Type of Visit: je Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: m Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: �L+ ,n t„ z TeH � j exc Fcr^• Owner Email:
Owner Name: L. ,n LJ 00j � �n �^ A � � Phone: qiD 2$9 O2,2tA X 8-5-7 p�
Marling Address:
Physical Address:
Facility Contact:
Onsite Representative: UVVW 7 01e1k___
Certified Operator:/
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C•urreat
Swine Capacity Pop.
Wean to Finish
Design C►urrent
Wet Poultry C►►opacity Pop.
La er
Design
Cattle Capacity
DairyCow
Current
Pop.
it
Wean to Feeder
Z.60r) a
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D , l;ovI Ca aci_ Pao ..
Dry Cow
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Nan -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turkeys
Turkey Pouets
Other
D_ischarses and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: T
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
�iC] No
❑ NA
❑•NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
No
❑ NA
❑ NE
the State other than from a discharge?
Page I of 3 21412015 Continued

I f
Facility Number: _ Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [!j� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ® NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes q No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes P] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes f� 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 1p No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes E] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Exceg-sive Ponding ❑ Hydraulic Overload ❑ Frozen Ground' ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN \ ❑ PAN > 10% or l O lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of-Acceettabble/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 6� 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 E7 No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA V NE
❑ Yes ❑ No ❑ NA qN_E
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes q 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 �p No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412015 Continued

Facility_Number: 3 1 - 3 1 Date of Inspection: 1ZjjS( 1-1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EA No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o
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 [_�JNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No
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:
❑NA ONE
❑NA ONE
❑ NA ❑ NE
NA ❑ NE
❑ Yes ❑ No ❑ NA '4 NE
❑ Yes []R No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes P No ❑ NA [] NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
[ E No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J;g No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to quesrion #) )Ezplaim-any YES,answers and/or. any additional recommendations or auyTother comments.
v
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1
Reviewer/Inspector Name: lca& W e'-3
Reviewer/Inspector Signature:
Page 3 of 3
Phone:���]�t�3��_
Date: y
2 010I5

Type of Visit:',(_"LB'mpliance 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: ry Arrival Time: j 16 ;_j�eparture Time: County: A4el 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:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
@apacity
Al —SwirtoFinish
We
Curren#
Pop.
Design Current III Design Current
Wet Poultry Capacity Pop. C*attle Capacit`° Pop.
La er Dai Cow
Wer
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Dry Cow
Farrow to Wean
Design Current
I) , Ca aci P,o ,
Layers
Farrow to Feeder
Farrow to Finish
Non-Dal'ry
Beef Stocker
Gilts
Non -Layers
Beef Feeder
a
Boars
Pullets
Beef Brood Caw
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes L2'No ❑ NA ❑ NE
Ely eIWO'No ❑ NA ❑ NE
❑ Yes. 2fNo ❑ 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 12'No El❑ NE
2. Is there evidetice of a past discharge from any part of the operation? _ mlyes �0' ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse.impacts to the waters ❑ Yes F /No ❑ NA ❑ NE
of the State other than from a discharge?
•a
Page I of 3 i' 21412015 Continued

�J
Facili Number: DInspection:
Wastes 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 E f 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 jE"No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 2�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 [2 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)
'2
9. Does any part of the waste management system other than the waste structures require
❑ Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �I o ❑ NA ❑ NE
maintenance or improvement? -�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �10 ❑ 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 La"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes E2,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes LZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes _�j No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes Z2'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑.?moo ❑ 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 21-1140 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection: J
24. Drd the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[] No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
❑ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
D NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C ] No
❑ NA
❑ NE
[:1 Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewed]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings offacilitv.to better explain situations fuse additional Daees as necessarv).
5 Jco toye- cchyl lz/-:il-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: d
Date:
14/Z015

(Type of Visit: _4D Cliance Inspection p Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: p Arrival Time: ;, Departure Time: County:
Farm Name:/y�/ 1�,� 6��.'/,�j� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
C►apacity
Current
Pop.
Ell
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
MIRMgn
1] , Paul
Layers
I
Ca aci
C+urrent
P,o P.
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Pg Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Turkeys
Turkey Poults
r 10ther
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ,Epo ❑ NA ❑ NE
❑ Yes IrlNo
❑ Yes ,EI-No
❑ Yes (EI—No
❑ Yes f❑ �No
❑ NA ❑ NE
0 NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: Date of inspection: "ZZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ,ETNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes [2No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
_,La"No
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes U7rNo
❑ 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 J2'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [ �' o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
7�
9. Does any part of the waste management system other than the waste structures require
❑ Yes _g�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 or improvement?
r2]
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ;JeNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes '0 No
0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Jallo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
'C2-No
17. Does the facility lack adequate acreage for land application?
❑ Yes J2'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J2'1Vo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ETNo
❑ 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 ED No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ 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 J:3'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

G
Facility Number: 30L jDate of Inspection: a /
24. ®id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2No [DNA ❑ 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 J?j 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
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
dNo
❑ 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
gTNo
❑ 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
OrNo
❑ 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
YNo
❑ NA
❑ NE
Comments {refer to question #f): Explain any YES answers and/or any additional recommendations or any other comments'.
Use drawings of facility to better explain situations (use additional pages as necessary).
110
!y - yv\ cc) -
� 12�4N
C� S�
IZ%,�1f3
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: InQ
Page 3 of 3 2/4 014

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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:171
cif
Farm Name: Li nf,)Q Q-te Sp.,Va , -y 13a ,s Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: o l'] f 0 0( �Ckq !L _ Integrator: (,�' /�
Certification Number: '� 11'J
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Region: , azq!!N
Swine
Wean to Finish
Design _ Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Design
C*attle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
a'X Calf
Feeder to Finish
Design Current
I) . P,ouItr. Ca aci P,o ,
Layers
Non -Layers
Pullets
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non-Dai
Beef Stocker
Gilts
Boars
Beef Feeder
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other.1
1 ::::]E
I
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes] No ❑ NA ❑ NE
❑ Yes �ZNo
❑ Yes P�110
[:]Yes eNo
❑ Yes PrNo
❑ Yes �o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: Q r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E:pNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): --------==—
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes Epo ❑ NA ❑ NE
❑ Yes r fNo ❑ 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 Eno
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes PNo
❑ 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
NA
❑ NE
maintenance or improvement?
T
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 E:(No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
',E17No
❑ Yes 2fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ff No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes -ffNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes AffNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑ Yes .E51No
❑ Yes �Ao
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes . o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z No ❑ NA ❑ NE
❑NA ❑NE
[DNA ❑NE
Page 2 of 3 21412011 Continued

Facill Number: 3 - Date of Inspection: -
24, Did tht facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �'No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes El"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 �j} 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/Jallo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ZNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ]�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 _]ZfNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �- to ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �YNo
N ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes ❑ NA ❑ NE
Comments (refer to question if): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitv to better exolain situations (use additional naRes as necessarv).
Af PAS
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
S urve-e-6 PIX �_
C6inl 5460'.
lam''
Vjkot
ccr,+� J aoj y
Phone: r
Date: f7 �% i-a
21412011

FaC-iI ity. Number D�
I:
ivision of Water Quality`
D;iDtvys�on of Soil and Water -Conservation.
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit -Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: .�c3Cj Departure Time: County: Region: _4
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: L=L)%& (,t2f Jeiak a S Integrator: 1W Adg25
C�
Certified Operator: Operator Certification Number:
L [ C-5 L io-1
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = 1 = fl Longitude: = ° 0 6 =
61
Design Current Design. Current ,
Swore Capacity iPopulafion Wet PoultryCapacityPopulation C
'. -
❑ Wean to Finish . ❑ Layer
❑Wean to Feeder ❑Non -Layer ❑
❑ Feeder to Finish a ° '° ❑
❑FtWean
o ean}
❑ D°ry Poultry.
w Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
E n Boars
Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
�m
yxk
attle
a�
z­
Dairy Cow
Dairy Calf
Dairy Heifer
DEX Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes] No ❑ NA ❑ NE
❑ Yes] No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ YesjNo ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes IdNo ❑ NA
❑ NE
1 Page 1 o, f 3
12128104 Continued

Facili Number: Date of Inspection: Z
Waste Collection & Treatment
4 " Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes VNo [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3(
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j ZNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Pj'*'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? //////'"``���'/
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0N0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
_;;?.No
❑ 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 o
❑ 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 PfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
TT
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall 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 YNo
❑ NA
0 NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: L
24. Did tke facility fail to calibrate waste application equipment as required by the permit. [] Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;TNo ❑ 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 �lo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes T�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes j27 No ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes I ❑ NA ❑ NE
❑ Yes N
o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Comments (refer to question #):.Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better expl ' situations (use additional pages as necessary).
iF2�11 C /"'
UO
.X 2 7//-z__. 2,13
s u:
1219l1i �� y Q 6ZLV
Fa,,-I'-i d- r.,e /o 01C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: j�/�- ?fw' 7! Vs -
Date: L 3
/,,,, a
2/4/2 ll

i`vision ofWater Quality
Faeiiity Number ®- O� Division of Soil and Water Conservation
DQ Other Agency
type of Visit: mpliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
treason for Visit: Q'&outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: ,,,, Region: `
Farm Name: L/n1aQ�.� sM Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: di�[��je�j
Certification Number:
Certification Number:
Longitude:
Design "Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
C►attle Capacity Pop.
Wean to Finish
I 11-ayer
Dairy Cow
Wean to Feeder
I INon-Layer
Dairy Calf
Feeder to Finish
iry Heifer
Farrow to Wean
Dpr Cow
Farrow to Feeder
D , P,oultr.
C►a aci
P,o -
Non -Dairy
Farrow to Finish
I
11-ayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
F
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Pther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�ZNo
❑ 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
Al
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
[] Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[]Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - 3 Date of Inspection: Z4LI /.T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P3 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 0 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 j' 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 ;3-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes � No
❑ NA
❑ WE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes Z] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes V'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes "ETNo
❑ 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 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes PTNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes XNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo
❑ 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 /6 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eo"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: Ll z
ll
24. Did the facility fail to calibrate waste application equipment as required by the permi ?
❑ Yes 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 ;rNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ,j No
[DNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 5�pNo
❑ 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 4!�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 ;�f 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 PoNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ZNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes XNo
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments '�F
Use drawings of facility to better explain situations (use additional pages as necessary).
(Ov tY4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
• � ��� ��. r,�r�l dal �
Phone: r �/yv� — 7R*,*3
Date: 11 A—
12141111

!Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
IReason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / r Arrival Time: j ,' Q Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Phone:
`Phone No:
Integrator•/
Operator Certification Number:
Back-up Certification Number:
Region: _6/6�
Location of Farm: Latitude: 0 0 = { = LL Longitude: 0 ° a A = 1[
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Popnlation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
El Dairy Calf
❑ Feeder to Finish
El Dairy Heifer
El Farrow to Wean
Dry Poultry
El Da Cow
El Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Layers
El Stocker
Gilts
❑ Non-ts ers
El Beef Feeder
PEIBoars
El Pullets
El Beef Brood Co
❑ Turke s
Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
I
INumber
of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E kRo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
ff o
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
Zo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
!(J No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PrNo ❑ 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZfNo ❑ 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 ALI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;�rNo
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PTNo
❑ 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 Soi
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
❑ NA ❑ NE
❑ NA ❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
,WNo
❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
Comments (refer to question #): ,Explain,any YES answers and/or any'recommendations ar any other comments --`�
Use -drawings of facility to better explain situations. (use additional pages.as necessary.)
Reviewer/Inspector Name d Phone:
Reviewer/Inspector Signature: "e--a Date: / -Ile
Page 2 of 3
I
Continued

Facility Number: Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [�No El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ✓❑ No ❑ NA ❑ NE
the appropriate box. ❑ W­Up ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5�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 9.110
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes )2No
❑ 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 oNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes ONo
❑ 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 Q-No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes P 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 ,O—No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes C3<o
❑ NA
❑ NE
Additional Comments' and/or Drawings
a
Q�yf�s
0 J 1
y
a, '76
/, q
Page 3 of 3 12128104

Type of Visit aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visitt 06outine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: V� Arrival Time:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Departure Time: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: _/I' `fJ
Latitude: = o = d = Longitude: = ° 0 t
Design Current
Swine Capacity Population Wet Poultry
Design
Capacity
Current Design C*ur•rent
Population C►attle Capacity Population
❑ Wean to Finish
ID La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
ID Non -Layer
❑ Dairy Calf
Dry Poultry
❑ Layers
❑Non -La Non -Layers
El
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
El Stocker
❑ Beef Feeder
El Beef Brood Co
Number of Structures:
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [Z No ❑ NA ❑ N E
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
IgNo
❑ NA
❑ NE
❑ Yes
ViNo
❑ NA
❑ NE
Page l of 3 12128104 Continued

Facility Number: ` — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;eNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No [INA ❑ NE
the appropirate box.
ElWUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes id No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
91No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
16 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
25 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
6 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
ElNA
ElNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comrnen#s'aad/or Drawings
/rlevel
(tll_ 'r
Page 3 of 3 12128104

Facility. Number: I —3C Date of Inspection / z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes dT o
❑ 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 A] 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 4:TNo
❑ 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 -fNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 4!5No
❑ 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 I�io
El NA [I NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes P No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
C'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No,
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 IZIZ61u4 c,onunuea

Type of Visit Pf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ORoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: -� Departure Time: County: / Region: LAI Zfi�p
Farm Name: �� _ _ _ _ - Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility° Contact: 1 Title:
Onsite Representative:.
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 00 =' [_]" Longitude: ❑° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
-21 V YM
/a 83
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Pouits
❑ Other
Discharp_es & Stream Impacts
f 1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Co
Number of Structures: �I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes _'No ❑ NA [IN I,
El Yes
El No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
El Yes
El No
❑ Yes
_2'No
❑ NA
❑ NE
[:]Yes
'ETNo
❑ NA
❑ NE
12128104 Continued

3°6
Facility Number: 3 Date of Inspection l d o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes giNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. L' ! Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ,aWeekiy Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking JZCrop Yield ja_120 Minute Inspections JaMorithly and 1" Rain Inspections Oweather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4EI'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes .8 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
Et NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
1:1 NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 2 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
LI-NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 2No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes ja-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 ;:LNo
❑ 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 E.No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [:],No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ NA
❑ NE
hawiional,Comii►enfs and/or Drawings
t ��Qase IreCvrd 4:'tezlo0afaf
o,G�t � poveC�
S d- Y) i4tc d o,�4,, `{ 04- MOY'e fay n-F-,i
lisp cc +10yN
�fca,rof
�C Se 6z o �' r1+2� Cow--bi o� R-82
a- OVA\ 3U mtriA Lrtsee-C 40.1 S
�- re L wp-c-Vfir c.aaO .
�}
�C Y ee-A——
12/28104

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,❑i '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): 6. �1
Observed Freeboard (in): _3 �^
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1c'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 .E�No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
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 [ lNo
[]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 JaNO
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
,12
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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Area
y❑
12. Crop type(s)r�llC!
13. Soil type(s)
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes J�ififo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',
El Yes _QNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes Lallo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2-iGo
❑ NA
❑ NE
Reviewer/Inspector Name (/ ��_ Phone: Uzi
Reviewer/Inspector Signature: e/ Date: ZV
12/28/04 Continued

(Type of Visit QGGompliance Inspection Q Operation Review Q Lagoon Evaluation j
Reason for Visit 9,Routine Q Complaint Q Follow up 0 Emergency Notification Q Other © Denied Access
g Facility ?Number 3Q
Date of Visit: /O c5' © Tune:
Q Not Operational Q Below Threshold
6ermittedE'Certified �] Conditionally CertiSed© Registered Date Last Operated or Above Threshold: _. W.
Farm Name: County:
Owner Name: _. Phone No: "
Mailing Address:..__
Facility Contact: .. ._ .._..... ._ Title: ------ . . __ _. Phone No:
Onsite Representative: ��Gy,rGjQ/ Integrator.
Certified Operator:. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 41. Longitude • ' �u
rwCmr
-
ean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
10 Gilts
_ 'C�erreat: _ » w _ Desaga ,_
L
rPanalattoi :. =Cat#ie ;CaDadt* =Pot1tilation-'
Other
a Total Design FCapacrty'
Z. TOW SSLW
Disaam" & Stream ts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
SI Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): - -
❑ Yes
FVo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
ONO
❑ Yes
�Vo
❑ Yes
,B'No
Structure 6
12112103 Continued

Facility Number: / -. Date of Inspection i
�. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes ,dNo .
seepage, etc.)•
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes ZNo
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,]'No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes -No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ yes _Z -Nv
elevation markings?
Waste Application
10. Are there any buffers that need maintenancetimprovement?
❑ Yes _21
11. Is there evidence of over application? if yes, check the appropriate box below.
❑ yes 0 e bT
"
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground Copper and/or Zinc
12. Crop type • s
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes 21NO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes &No
b) Does the facility need a wettable acre determination?
❑ Yes 'C�No
c) This facility is pended for a wettable acre determination?
❑ Yes ®'Nb
15. Does the receiving crop need improvement?
❑ Yes _C],No
16. Is there a lack of adequate waste application equipment?
❑ Yes gNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ yes —[31Qo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes PNO
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes PNO
roads, building structure, and/or public property)
20. At the time of the inspection slid the facility pose an odor or air quality concern? If yes, contact a regional
❑ yes J�13
Air Quality representative immediately.
use drawn ; *2taeWrptatn snuanoas. toseaddzUonat.pagss as aecrssary) ❑ Final Notes
:`.._. tt. .....� 3s..:-:�:� .-w�.a_ `"� -..---_•••-•- .. �:, ..... �,;° " `�+f;......e`.�'i�;, y
ie Copy
ReviewerA spector Name - � � .-
Reviewer/inspector Signature: Date: /CU
t

Facility Number: ' — Date of Inspection U l/
Reouired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 0'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 2TNo
23_ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P4o
❑ 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 ;a-fIo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes .F.,No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes jQXo
27. Did Reviewer/inspector fail to discuss reviewImspection with on -site representative?
❑ Yes ,lido
28_ Does facility require a follow-up visit by saute agency?
❑ Yes _S'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Cl-IQo
NI PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes FWo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number 3 Date of Visit: 4Z Time:
IQ Not O eratinal 0 Below Threshold
® Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated
��orAbove Threshold:
Farm Name: 4'e v ' r County: 1-2019 ''`h
Owner Name:
Mailing Address:
Facility Contact: yyy� Title:
Onsite Representative: ePwlt C,--
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:si
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 K Longitude a 4
Design
Ca aci
Feeder z400
to Finish
Current Design Current Design "UburrentSwine
P,o ulatioa PoltCa aci Po ulation Cattle Ca aci
❑ Layer ❑ )airy
❑Non -La er ❑ Non-Dai _�J
o Wean
o Feeder❑Other
EFarrow
o Finish
Total Design Capacity Total SSLW
Number of Lagoons 0AWEER
g Ponds lid Traps
Holdin/So
bsurface Drains Present ❑ La oon Area ❑ S ra Field Area
Liquid Waste Management S stem
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes &I No
Discharge originated at: ❑ Lagoon ❑ Spray Field. ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
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 'R No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �R No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes JZ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches): ZCo
05103101 Continued

Facility Number: 3% ` 3Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El No
p Yes
(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 10 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? R1 Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes B,No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 91 No
1 I . is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload El Yes allo
12. Crop type /�jyladl4 J;14�� .'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes R] No
16. Is there a lack of adequate waste application equipment? ❑ Yes [INo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
allo
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
IkNo
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
[ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
® No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[j No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coinmen6l(refer to uestinn #): Ex lain -en YES;.answers and/or any" recommendations _or an 'other'comments,
Use drawgs of facffity to better explain situations-. (use additional pages as necessary) ❑ Field Copy ❑Final Notes
..<
4g //ra 4/mu_W 7x'r", is 1T hee." S fd D� %iir�rndP� / fie— evt r/
e4 7 /1 f d' X c:t 4V" 41 tA1 �i�f`P� AJt e4 7-0
601-14 V'
Reviewer/inspector Name —�
Reviewer/Inspector Signature: Date: />
05103101 z %
Continued

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ 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 CRNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes NJ 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 B 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/or Drawings:
w
05103101

Facility Number Date of Visit: /2 Time: Dd
O
Q Not Operational Q Below Threshold
Permitted U Certified © Conditionally Certified 0 Registered Date Last Operated or Above
/Threshold: ........................
FarmName:......................................................................................... County:!'..............................�...» ........
OwnerName:..JI �LeO�Q Q........st1-............................................... Phone No: ................................................................. .......... ...... ..
FacilityContact: ......................................... .......... I........................... Title:................................................................ Phone No:...................................................
MailingAddress:..............................................................-........-....-._...............-_........._......................._....................................................... --�..... �... ..
Onsite Representative:..A�Q d�/"K l.4�S... . Integrator:. ,ll..I(��} �"lT t ...........................
.................... ........ .... . ..
Certified Operator: .............................................. Operator Certification Number:......,............
Location of Farm:
E'Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 66 Longitude • 4
Design Current .. :.: Design:. Current-
Capacity- Poelation Poultry CapacityCipacity Population Cattle
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I ❑ Dairy
❑ Non -Layer I I 1 10 Non -Dairy
❑ Other -
Total Design Capacity `
-Total SSL W
Number of Lagoons :_ ❑ Subsurface Drains Present ❑Lagoon Ai
`>)Elolditng Ponds LSoiid Traps. ; ; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ,j No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes jf'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Rf No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O'No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches)
5/00
Continued on back

Facility Number:_VE124
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,jErNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes PNO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ):�No
11. Is there evidence of over application? ❑ Excessive Ponding [] PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes f71"No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 100
b) Does the facility need a wettable acre determination? ❑ Yes 0No
c) This facility is pended for a wettable acre determination? ❑ Yes fOINO
15. Does the receiving crop need improvement? - ❑ Yes �No
16. Is there a lack of adequate waste application equipment? ❑ Yes IKT&o
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ONO
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 43"No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes pfio
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes � No
22. Tail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 00
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes J3No
24. Does facility require a follow-up visit by same agency? ❑ Yes 0'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 010
0..i4•Yiolotioils:ot- 00fcietls: 0$ v.Vre poed-atrh �his;visit; Yoji will•tec�iye titi uith�r
cori�es o deike: about this :visit: ... .
Comm —'(refer tqi gtteshon #) lExplaui any YES answers and/or anyerecommen'dations or any other
Use d=avviags of.faciltity to better a plain'situations. (use additional pages as iuecessary) ,ter
_ :.
lei 416A
S�LrCXi9t,�S
7Sq°gS��F�CF?•�zil1 Lr/F �.Q�Gr
W �-5 i/ f G�}!✓ �o sue' w - .G/UCiC�ig- 5� �Q�/ �,�/�
a
Reviewer/Inspector Name rG�'_` _ - :
Reviewer/Inspector Signature: Date: 5/00

Facility Number: 7W Date of Inspection /21
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0190
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes B No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ENo
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 f-' No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes .ENo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ ,_,
Yes NO
AdditioComments an or. rawtngs: m
IJ z� �F /tf�zS ,ate
.
4-
t, oA1o Z Tzo nJ
5100

`Division of Water Quality
0 Division of Soil and Water Conservation -
0 Other Agency
Type of Visit WCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit xRouline O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit- ®'Ciine:I 1000 1 Printed (pit: 7/21/2000
0 Not Operational 0 Below Threshold
13 Permitted KCertified (3 Conditionally Certified © Registered Date bast Operated or Above Threshold: ................
FarmName: 4................................................................. County:... ( \ �.,............................... ......................
Owner Name:
.......... Phone No:.... ..................................................
FacilityContact: ...................................................................... ........ Title: ................................................................ Phone No....................................................
MailingAddress: ................................................................................. ............................................................................................
Onsite Representative: INS ........ Integrator: „•• ► ` LIB
r....................
Certified Operator: ......................................... Operator Certification Number
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° �-� Longitude
Design Current Design Current Design Current
Swine Ca aci Population Poultry Capacity Population Cattle Capacity Pol2ulation
Wean to Feeder o'cGd ❑ Layer ro
Dairy
❑ Feeder to Finish ❑ Non -Layer 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-mn Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact~
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If'discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 9No
[:]Yes ❑ No
(:]Yes []No
❑ Yes ❑ No
❑ Yes WNo
❑ Yes XNo
❑ Yes XNo
Structure 6
Identifier: ......................
Freeboard (inches): q3
5100
Continued on back

Facility Number: d Date of luspection 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 J (No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure'plan? ❑ Yes WNo
(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? XYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance improvement? ❑ Yes IK No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes NrNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN (D Hydraulic Overload ❑ Yes XNo
12. Crop type -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? El Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes JZNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? XYes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ONO.
16. Is there a lack of adequate waste application equipment? ❑ Yes 'ONo
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes WNo
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 b�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) Oyes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes )S No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
23. Did Revi ewerA nspector fail to discuss review/inspection with on -site representative? ❑ Yes
24. Does facility require a follow-up visit by same agency? ❑ Yes �No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes JXNo
• ............ . .were noted dirrtnis:v.. ... * ... i-e. . . . t.. t'... . .
cor'res�6iidence: abi A this visit. :..:...... .
Commeets (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):
�Ca^e.�'..
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Date: { j _ �-�aa — 5100

Facility Number- Date of Inspection 16 o 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 attor Mow ❑ Yes �NO
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes I�No
32. Do the flush tanks lack a submerged fill pipe or a peimanendtemporary cover? ❑ Yes 21 No
ittona < omments and/or.Drawings:
die►-,s�-e� . �e as e cL,�,,_..Q,..� � ��� ,r �d
J
5100

E3,Dtvasaon of Soil and>Water'Conservation Qperatioai Review
s.
13.Division of Soil and Water Conservation CompIiancc Inspection j
ADavision of Water Quality Coanplaance Inspection
EUthei Agency, Operation Review-
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other I
Facility Number I Date of Inspection /
Time of Inspection / 24 hr. (hh:mm)
0 Permitted ,d Certified [3 Conditionally Certified [3 Registered Ili Not Operational Date Last Operated:
....................
Farm Name:-...i!/ld �.J�kira/s,r'. County:.-..-.....��.�`�........................ w%o.
Owner Name:......-..-
It 't/. r ............. .......�K............-...............-.-........-..... Phone NO:...... j0....... 4� r. .rJ- ....................
Facility Contact: ....... ......�].,11'M.� ....................................... Title .. .... Phone No: ...................................................
Mailing Address: ..... I !�6....... eypoebs.� 17............... ............L/11 Lt!� �..-.....:r�l�%.............
Onsite Representative: �/n!!r(/ �.. ��-�/!'�1 � Integrator: I��j •••••...
Certified Operator:.... .... 0.2-....... 1f„•...... ..................... Operator Certification Number:.....�1� S�i'
Loci •on of Farm;
m..............P...........! .............: o.........a......... ............ 1:............... ..P...S.S........��K.....
r
Q...-.c P .� s...G �-... ..-. .._..... Z ..._....>?� �5`..,r �........f-.c e ....o. ...r. F1...... 1....s .... l .e4o......
Latitude E • EYn` =
Longitude =' ET4D4 4«
- Design Current
- v -
Design Current
Design Current -
Swine Ca aci Po Mahon
ty
., Point r3'
Ca ca Pa ulataon C..attle
ty
Ca acity Population _;;.
Wean to Feeder
❑ Layer
❑ Dairy
;, [] Feeder to Finish
Non -Layer
1[j Non -Dairy
❑ Farrow to Wean
w:
—
a
❑ Farrow to Feeder
❑Other
`
❑ Farrow to Finish
-
W TOttal Design 'CAP ty
—
.; ❑ Gilts
❑ Boars
_
_.
= T01Ia1 SSLW
Numb& of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ea ❑Spray Field Area'
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No.
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convevance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the Stale? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min'?
❑ Yes [:]No
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? �LOodi_ 8l' 1dcheRlC.it/1le lFLO41b)(Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [] Yes f�No
Waste Collection & Treatment �'
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ........ ........... .................. ..................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3123/99 Continued on bark

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes No
(If any of questions 4-6 was answered yes, and the situation poses an ������////``����
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any pats 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 ADDlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12.
Crop type 67e71ob C s4qe,7
13.
Do the receiving crops differ with those designated in the Certified Animal,Waste Management Plan (CAWMP)?
❑ Yes
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
If No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
0 No
15.
Does the receiving crop need improvement?
❑ Yes
ONo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
P.No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
)d No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
eNo
(ie/ WUP, checklists, design, maps, etc_)
❑ Yes
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
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑
Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ANo
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
N,6-*iolatiOris:or deficiencies -were h4f d• during thi' :visit'. You "All-e&6ye do further
correspondence. about this visit. • ... ....
Comments (referMto question #) Explain any.aYES answers and/or any recommendations o%any of er comments
Use;drawings of facile to better: ex lain situations use_additxoaal-"_a es as.neccssa ) - ' -
ty =_ P ( p _ ry
Rk-Cor»m xla AIA t/pA/4 GTA V*M�,2� �,� /.✓ GAc,-� Al .PE
Lk��n/ Lt1Rt:� ��1eGi !JP 5' C�fJd4e A4LC 4S1,e ge-tok 1 �FC7-1AG
S410tr�r ��'�i2���/C 4h46-,'>1/ Zo
3� v�v�-re p-ca pe .4PpetfiN6 J"b
Reviewer/Inspector Name
j4
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: — Date of Inspection �/� :
Odor Issues ,ram-- 9
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ;No
liquid level of lagoon or storage pond with no agitation? '' `
27. Are there any dead animals not disposed of properly within 24 hours? ❑ 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 0 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
3 L 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? N lA ❑ Yes ❑ No
3/23/99

o
Lagoon Dike Inspection Report
� U
b P P
Name of Farm Tacility L I'A L,(jQ0
Location of Farm/Facility ran YIJ� {�'S' �—re-edc_ C, BOYS
1
Owner's Name, Address � , 0 0 d J-r••Cr� -- xa6
and Telephone Number
/c e C.7 A)C. 1;(fy6Z (::q:a�1us—
Date of inspection p(� S' Names of Inspectors C��/(%Q/�
G r C
Structural Height, Feet Freeboard, Feet
Lagoon Surface Area, Acres See— CtA,v 5e Top Width, Feet
Upstream Slope,xH:1 V Downstream Slope, xH:1 V '5ireiVe
Olf Sr .r�
Embankment Sliding? Yes X No
(Check One, Describe if Yes)
Seepage? Yes— No--
(Check One, Describe if Yes)
h,- nt I y eo, c c, Vel y
06cc e
Erosion? Yes No
(Check One, Describe if Yes)
Condition of i I` U 6 c �c
Vegetative Cover
(Grass, Trees) 0 5 v
D' Dik Overtop?} Yes No If es, Depth of Overtopping, Feet
,� �o �` C�� Pv 4o QvCi �a
Follow -Up Inspection Needec? Yes No
Engineering Study,Needed? Yes ,. Q_
Is Data Jurisdictional to the Dam Safety Law of 1967?
Other Comments LGk 91 00 r�, 1
cl," 4 2 �
t(�C7va
4�
M/'
Yes No
0
Gr,-c-1� t A
S L
nr1C,— -�>

2S&
f Vt ",/ C, t I

Longitude �� ®� ©{
=1p Non -Layer 1 1 I'' I❑ Non-uatry
tine p t omplamt p rollow-up of I)WV inspection p
Facility Number
p Permitted M Certified p Conditionally Certified p Registered
Farm Name: Linwaod..lenkins.Far.m..............................................................
Owner Namc: Linwaod................................ Jenkins...................... ..................
Facility Contact:
-up of U5WC review 4p other I
Date of Inspection
Time of Inspection 24 hr. (hh:mm)
p Not opera hona Date Last Operated:
......... County: Duplin WiRO
Phone No: 91117285=760ft ..........................................................
Title: .....................
Phone No:
MailingAddress: Abfi.Cypress..Cx_ek..Rd..................................................................... Wallact..XC ........................................................... Z8461G..............
Onsite Kepresentative:.......................................................................................................... Integrator: Marphy-Fami1}Eaxms......................................
Certified Operator: LinwondJL......................... deakins ............................................. Operator Certification Number: 19.654.............................
Location of Farm:
Latitude ®0 ®4 ®«
Ca
® Wean to Feeder
2600
❑ Feeder to mis
❑ Farrow to Wean
❑ Farrow to Feeder
p Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? p Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) [3 Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes []No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [:]No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway []Yes []No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inclies):...............z0............... ...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23/99 seepage, etc.)
[]Yes p No
Continued on back

Facility Number: M-306 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? []Yes []No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes []No
8_ Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes p 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
❑ No
11. Is there evidence of over application? []Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14_ a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
Cl No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
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
p No
19. Does record keeping need improvement? (ic/ 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
❑ No
21. Did the.facility fail to have a actively certified operator in charge?
p Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
U - N.o.viul'ations•o' _& icier•6e's.were•no'ted:durin'g.this visit.':Yuu: ivill:receivp' na furtiter. ;
. • . • .correspondence. about this:Visit: . . . ............................... .
Visit.' -
farm flooded including lagoon (inundated) and hog house. 2300 hogs were lost. (Water on dike wall)
non-DSW) Very little dike, lagoon mostly is in the ground. Ground is very soggy on backside of dike. Vegetation is
with some bare spots. Lagoon is in pretty good shape, a little soggy but no structural damage observed.
Reviewer/Inspector Name MGre rcVikern Gannon DS
- d�7 7_
Reviewer/Inspector Signature: Date:

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 3 Time of Inspection p S 24 hr. (hh:mm)
© Registered Certified 0 Applied for Permit [] Permitted JE3 Not O erational Date Last Operated: ,,,....
Farm Name. L: hnpgor ......y�P.�.�:nS..... r_ac r................... County: ....... J .p.�.^.............................................................
Owner Name: ...................... Liv.,aw)......... ..Imy i x....................... .......... Phone No: 9 D Z — 1, 60
Facility Contact: --....... ................ .. Title: . Phone No:
Mailing Address:...... .�x.%........C.r7r s...... k l ....:... _...................... .f....... 2 4
OnsiteRepresentative:............1�1y, .4G......�P� �t±S.................. Integrator: .......�!�uq.------.................
Certified Operator; ................................................. ............................................................... Operator Certification Number.........----...........
Location of Farm:
x-....M!...........'Sat ..... d... .. Sl e.}..�...... cj�-s....... a.......:SE 1........................................................................................
.......................................................................................................................................................................................................................................................................... �
Latitude C�•:L.�l` �" Longitude �• ��
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 14 No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
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 gaUmin?
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?
C. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes ® No
❑ Yes M No
❑ Yes ® No
❑ Yes K) No
❑ Yes W No
❑ Yes No
❑ Yes No
Continued on back

F acilitk l�umhc r: 3 ` —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (l.agoons.11olding Potn[Is, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard {tt): ............ z: ...............
.............................................................................................
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 M No
❑ Yes ® No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? .
Waste Apniication
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 .................. 6.mUf1.G.................... ......WM11...... .AiCE.u�................. ............. .............. .................... ......................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the.facility have a lack of adequate acreage for land application`'
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative"
22, Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP"
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations or deficiencies were noted -during' this.visit.- .You.will recei've-no further
correspondence about this.visit.- .
[]Yes O No
[]Yes O No
❑ Yes [b No
❑ Yes MI No
❑ Yes ® No
ElYes In No
❑ Yes Mo
IM Yes ❑ No
❑ Yes 51 No
❑ Yes Q9 No
❑ Yes [�)No
N Yes ❑ No
❑ Yes ® No
❑ Yes P No
❑ Yes ® No
Comments(refer to ques#ion #) Explain any Y l;S answers andlor`anv recommenilattons:orony other continents „
Usefdrawitigs of facility to better explain situations, (uSc additional pales as necessary)
l'�1'GJ►�.+SYCI(p�
u'�� be oi.. 5�+ �f�(�-�tl�� Z- ��'»�S. �Ya.+ 1-CCUrVS ,fqr` �!'
o�. bQYr>UJtl a S F SOU � D e 0 �'W. corwb;,v ALA_ �,� �Urn��v
C61teKi�t' c l c-vlckfi r� 1 -t- +1� ef- IGt�ce, eC f i t7Y0.itGn jn T ` f�'
rej'c
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

K ❑DSWC Animal Feedlot Operation Revlew f`
DWQAn1ma1 Feedlot Operatlon 51te�Inspectlon� �`�
itoutine 0 Com faint O Follow-u of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number
Date of Inspection 7
3� Time of Inspection 24 hr. (hh.mm)
Total Time (in fraction of hours
Farm Status: Registered [I Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted I or Inspection includes travel and processing)
❑ Not Operational Date Last Operated: .. _... .. _........._ .................... �............. _... ....._...... ......_........
FarmName:�Y!�.....C4Yu....... .... .... __...._W....__............. County:._...Iz[1.._ .... .»...._ .... ..
Land Owner Name:- x (ESL .. i "
...�,1.c.�.�a!(��.._..............................................� Phone No: i�. �� Z�¢S2Q..........................................
Facility Conctact:... �3x t .... _"�. ! u1S...................... Title: ._D .} ,XX......_�_........_�.I..-_-. Phone No: .LCi1i}).a5.:::3.k OQ._........
Mailing Address: _ _DLa �.. S_..Ci ... Njr....---- .......-..._..... .......
Onsite Representative: p ....."-- . ..... lek�Tt�C).5....._._....._................................. Integrator:......
Certified Operator: _. ,,�t�o� !...... 1e�ist,z .... _.._ _...._._.... Operator Certification Number:.1,�1,,. ..,, _..
Location of Farm:
Latitude E:I• EED` ®- Longitude
Tvne of Ooeration and Design CaDacity
6A LL)
ren
aP,.C`ae
DR
Ciokk`SSyesign _ Current
C8 aciPo� ulation
Wean to Feeder ZOO Layer Dairy
El Feeder to Finish ❑ Non -Layer ❑ Non -Dairy I
11 Farrow to Wean g * ml
t
Farrow to Feeder Totidibdtgn Capadt
Farrow to Finish ;
Other T
TOtai i Doo
� S
s Lei`
Numrber of Lagoons/ Holdrng Ponds _- Subsurface Drams Present
P x� f� r
H
is ❑ Lagoon Area Spray Field Area
n ra
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
4/30/97
❑ Yes En No
❑ Yes M No
❑ Yes
No
❑ Yes
No
❑ Yes
1 t1 No
❑ Yes [% No
❑ Yes JANo
❑ Yes W No
Continued on back

Facility Number: ..... .}.._.. �...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 69 No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures_f[.agoons and/or Holding iPonds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure ! Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes ® No
❑ Yes 09 No
[I Yes PQNo
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crope ..........CQ�.-...ltl�aim....................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection"with on -site representative?
JEoL Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes No
❑ Yes No
® Yes ❑ No
❑ Yes JN No
❑ Yes §9 No
❑ Yes ®No
❑ Yes E4 No
�] Yes ❑ No
❑ Yes [j] No
❑ Yes ($ No
❑ Yes & No
Yes ❑ No
❑ Yes [PNo
Yes ❑ No
y . ndions ar an r comenComments reer to' estion x !am any YES;answers and/oran recommethets
Use drawrngs of facility to better explain sitvattons :(use addtt�onalpages as necessary}
T'A-o
' taalt: Skoula W'Dwel 9,LCIC 6 PiV�G Srtnac�[r} Loveve_ ire
4
ce �o,r Yln . C O�uWJi V t>
,,11 �II=DjfS
r.Vwv1J b% Vtt—Ordeo 0 s CUAJ W', %�rlr�Y-6 YXAO st10UW
1
cc: viviston o] water &juawy, water Vuatuy aectton, Caciiity Assessment Unit` 4/JU/9 t

Site Requires Immediate Attention:
Facility No.�
r , DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: D
Farm Name/Owner: Q0Ai
Mailing
County:
Integrator: Phone:
On Site Representative: . ^ �r oa J Tin. K k Phone: — % o
Physical Address/Location. _ a-n n 2. r.,v. 1,1
Type of Operation: Swine _� Poultry Cattle wt. -'c
Design Capacity: 2 a l7 Number of Animals on Site:
DEM Certification Number: ACE, DEM Certification Number: ACNEW
Latitude' �+ '�i/ 7" Longitude: -j -7° �1�i' _ 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) &r No Actual Freeboard: Ft. Inches
Was any seepage observed from the iagoon(s)? Yes or -Was any erosion observed? Yes oto
Is adequate land available spray? r No Is the cover crop adequate? 0 or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin6s�7Y� or No
100 Feet from Wells? (�5or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes of 60
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 00 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated.on specific acreage with covei crop)? Yes or�
In ector Name 5ignature
w
cc: Facility Assessment Unit Use Attachments if Needed.