310307_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

f17
Type of Visit: 45 Corn ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: lTr i r Arrival Time: EUTiEl Departure Time: p County: Region:
Farm Name: S [�� �,tJp�y Q 44PO-, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: ,�% It �1 m4 e- r✓
Back-up Operator:
Title:
Phone:
Integrator: ► s
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Curren# Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Finish La er
Design Current
Cattle Capacity Pop.
Dai Cow
Feeder
2 6
p Non -La er
Dai Calf
o Finish
Dai Heifer
o Wean
o Feeder
o Finish
F
Design Current
Dr, P.ouIt , Ca aci $o ,
La ers
D Cow
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Boars
Other
Other
jPullets
Turke s
Turkey Poults
Other
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?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ❑ 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)? l
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes rNoE]NA.
A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? 0 YesA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NE
of the State other than from a discharge?
Page I of 3
214120I5 Continued

Facili Number: - p Date of Inspection: ,L -JI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36 'I
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 13ar /" I- Qlpv 51"' } -. 1 n--f
13. Soil Type(s):
14. Do the receiving craps differ from those designated in the CAWMP? ❑Yes [*�Np' ❑ NA ❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C3'N o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?.
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rNo'
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciliiNumber: - Date of Inspection: / —11—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes��No�o 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 N NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[::]Yes 0 No
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
Comments (refer to question #):•Explain".auy: YES. answers and/or any additional recommendations or any"other comments: "
Use drawings of facility to better exoNin'situations (use additional pages as necessary).
kv
6 3 ��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:'q(Cl _]01/ y Z06
Date: I �1 — // —1 2
21412015

(Type of Visit: �Com Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit; Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit:
L! Arrival Time:
eparture Time: County:
Region:
Farm Name:
Ad4Owner
Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: rj Title:
Onsite Representative: LC/
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /" /E5
Certification Number:
\
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design C►urrent
Wet Poultry Capacity Pop. C+attle Capacity Pop.
Layer DairyCow
Wean to Feeder Z
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
1D , l;ouI Ca aci P,o , on -Dairy
La ers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Gilts
Boars
Other
Other I I j
Turkeys
Turkey Poults
Otber
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 ZNo ❑ NA ❑ NE
❑ Yes jfNo ❑ NA ❑ NE
❑ Yes XNo ❑ 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 Z)i❑NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impactsto the waters ❑ Yes o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: L - Date of Inspection: !
Waste Collection & Treatment
4. Is storage capacity'(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EZO
NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ 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.,JTNo ❑ 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 El"No ❑ NA 0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes �No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ETNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes F,o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
0 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 J:, 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 �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes o ❑ NA ❑ NE
❑ Yes [3"'No ❑ NA ❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes oNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes L2r'�o ❑ 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 Plo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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 INO
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection: l
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
0 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
KNo
❑ 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
J2"No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
eNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
4!1 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
E!fNo
❑ 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
JZ—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
6'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
16"No
❑ 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
VNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers andlor any additional recommendations or. any other comments. Fe ;
Use drawings of facility to better explain situations (use additional pages as necessary).
7/,.
��,_rllq 11 Tf
1/,-//3 /_ L--*
Reviewer/Inspector Name: Kf'1J PN_ / Phone: 7Q �
Reviewer/Inspector Signature: �, Date:
Page 3 of 3 2/ 0 4

Type of Visit: ,0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: gd�outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 9;� Departure Time: County:,% Region:t.`/
Farm Name: 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:
Certification Number:
Certification Number:
Longitude:
Design C+urrent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Finish
Design
C►attle Capacity
DairyCow
Current
Pap.
Feeder
Non -La er
DairyCalf
o Finish
DairyHeifer
D Cow
Non-Da'o
Beef Stocker
JLayer
o Wean
UFarrowo Feeder Dr, P,ouIt .
Finish La ers
Design Current
Ca acity P,o ,
PNon-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
. a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 1:2 No ❑ NA ❑ NE
❑ Yes No
❑ Yes [/] No
[-]Yes 0 No
❑ Yes zfNo
❑ Yes 2f No
❑ NA ❑ NE
[DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: [j Date of inspection: z j,3
Waste Collection & Treatment
4. Ii storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZ"No
a. If yes, is waste level into the structural freeboard? ❑ Yes P No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �o
❑ Yes 9No
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 'FJ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 7No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [;allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 2 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ONo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes O.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z, a ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? . ❑ Yes ]No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes )2'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes EjNo ❑ 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 RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ 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?
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 y No
[:)Yes 2 No
[] NA ❑ NE
❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes PJ�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes VNo ❑ NA ❑ NE
Comments (refer, to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use, drawings of facility to better explain situations (use additional pages as necessary).
bluiq
$1///3 /.Lv
3,/31/3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
PhoneA�/ ���3�
Date:/Z l� /
Page 3 of 3 21412011

Nw.
Facti�ty Number
w
evivisio.n of Water Quahty,
K
O'Division of Soil and Water-Conservateon,
Q'OtherAgency� _ .' T111
Type of Visit ,oZoGnpliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 2n
utine O Complaint O Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Z/ Arrival Time: T Departure Time: County: Region:(,_h��
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = [� Longitude: = o ❑ , ❑ if
o -
Design Carenf Design
Swine 4 Capacity Population Wet Poultry Capac�tyl
❑ Wean to Finish ❑ Layer
A❑ Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish
] Farrow to Wean " Y
-Dry Poultry
] Farrow to Feeder
❑ Layers
] Farrow to Finish
❑ Non -Lavers
] Gilts
❑ Pullets
Boars
h;
h `. ➢
fthet ��-
❑ Turke s
❑ Turkey Poults
] Other
❑ Other
rrentw -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
Dairy Catf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
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 Q' o ❑ NA ❑ NE
❑ Yes
P'No
❑ NA
❑ NE
❑ Yes
J2[No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Jallo
❑ Yes if No ❑ NA ❑ NE
❑ Yes ,eo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: r1, / - ?k-77 115ate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structured 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 JaNo ❑ 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? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONO ❑ 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 2fNo ❑ 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 eNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ff No
❑ Yes dNo
[:]Yes VNo
❑ Yes [3"No
❑ Yes ONO
[:]Yes 8 No
[—]Yes 0No
❑WUP ❑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 0No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo
Page 2 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes -d No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [?-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 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 appropriatz box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [ o [] NA ❑ NE
❑ Yes P�No ❑ NA ❑ NE
❑ Yes ,[?I No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes j2rlNo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes � o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes Wo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).'
!& N , Oe sure �a- &g� s( s
boo C9.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ry" ;;�_ AS6
Date: /WV //:z
2141201

Faeility Number, d 4 •.
�yision of;Water Quality
O Division of Soil and Water Conservati
O Ot1►er Agency
Type of Visit �,Coommpliance Inspection O Operation Review O Structure Evalurion O Technical Assistance
Reason for VisitJQ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access /
Date of Visit: 7- / /C/ Arrival Time: Departure Time: County: Region: !'AA� r
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: j Title: Phone No:
Onsite Representative: _-�i - W Ci Integrator: ZY1
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = ' 0 « Longitude: = o
Design Current
'Design
sCapacity._.Population
Wet Poultry -:Capacity_
Wean to Finish
❑ Layer
Wean to Feeder
L
❑ Non -Layer
Feeder to Finish
Farrow to Wean
Dry -Poultry
Farrow to Feeder'
r+
0 Layers
Farrow to Finish
Boars
Non-
Pulle
El Turkey Poults
Other ❑ Other
�— �­77—�
Cow
Calf
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
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?
Page I of 3
❑ Yes �o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Dyes
,❑]�No
1GNo
❑NA
❑NE
❑ Yes
JCi No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection �-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P'1Qo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ONo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G� y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J2'No ❑ NA ❑ NE
(ieI large trees, severe erosion, seepage, etc.) ^
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �d 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 )�I1No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes J2'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4D7176 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes TNNo ❑ 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
O-1Go
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑moo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E]'�_No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2rNo
❑ NA
❑ NE
l8. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
_' , , ��"_ F
Comments (refer to questron #) Egpla�n any YES answers andlor any "recommendations or any other commentsW.
Use ilrawmgs,of fai ility to better explain .situations. (use addihonal pages as necessary):
Reviewer/inspector Name
Phone:
_
Reviewer/inspector Signature:
Date: y
Page 2 of 3 1212W 04 ` Confinued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Piqo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other �
21. Does record keeping need improvement? If yes, check the appropriate box below. El2 Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
El"No
❑ NA
❑ NE
23. , If selected, did the facility fail to install and.maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2'N' o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,LEI No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0'l 1�o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5�' "�
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Oo
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
2'&o
❑ NA
[I NE
and report the mortality rates that were higher than normal?
JC
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
Pi0
❑ 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
dN(o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
� /No
❑ NA
❑ NE
Additional Comments and/or Drawings:."��>
C)_ Yo
Ae,!,el, rev se,� A /,:7,/,,j
66 51tL6Csi S' ctT✓ eqr- 1 Cv
V1 l '�
%L-ar-ol�1' �l/o� cic o/1
Page 3 of 3 12/28/04

IType of Visit QrC.ompilance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit efRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1i rrival Time:f Departtuure Time: County:
Farm Name: tt Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: GLL�
Location of Farm: Latitude: = o = A = ii Longitude: = ° = 1 = ..
Design Current Design Current
Design Current
Swine C+apacity Population Wet Poultry Capacity Population
Cattle C►apacity Population
❑ an to Finish
❑ La er
❑ Daia Cow
❑ an to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder
❑ Boars ❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other ❑ Turke Poults
❑ Other ❑ Other
Number of Structures:
oleo SIM
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
1 Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes PINo ❑ NA ❑ NE
❑Yes
El No
El NA
❑NE
❑Yes
❑No
❑NA
[I NE
El NA
❑NE
[:1 Yes
[:1 No
❑ Yes
No
❑ NA
❑ NE
'e
❑ Yes
ZrNo
❑ NA
❑ NE
1228104 Continued

Facility Number: �" Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA [:)NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [rNo ❑ NA ❑ NE
Structure I 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
ZNo
❑ NA ❑ NE
Oe/ 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
ZNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
PfNo
❑ 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
PrNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
VNo
❑ NA ❑ NE
maintenancelimprovement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
EQ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ENo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
{J hlo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Flo
❑ NA
❑ NE
�Comme 1NI(refer�to"queshan #) Explain any YES :answers*and/,Corpany recommendat,o©s.or any'otiZer comments..
Use drawings of facility to better explain s>ttuafions(use"additionalfpagesasinecessary)
--. k4 ;s asm.,sww's .. a.. - ' ..#ra":,a .s.,a r.:...., f.p3 .'As*,�'x.'r an &.. 3 $++Y A-a-p=•�.W+ j{y `!
Reviewer/Inspector Name / Phone:
Reviewer/Inspector Signature: Date: cam'
Page 2 of 3 12128104 Continued

Facility Number: • — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes Q<o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZrNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �kNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C;�NO
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ef-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
YNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�lo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
21No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ER 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
E'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
E5-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
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
,.
Additional Comments and/or D`rawmgsz ; to wtaa
�/�a • 7 / IS
Page 3 of 3 12,128104

4
�'6ivision of Water Quality
[Facility Number 3Q7 O Division of Soil and Water Conservation
— - - -- Q Other Agency
Type of Visit Ge6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit-EMoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time 001 Departure Time: County: `+' Region: W l /
Facility Contact: Title:
Onsite Representative: ,SCA Vn 14 cnc1y►
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification t.)..ber:
Back-up Certification Number:
Latitude: E__1 o EJ' E__1" Longitude: 0 ° [� 4
Design Current::' `� „DesignCurrenf` -�'Design'
Swine: Capacity Population Wet Poultry Capacity Population Cattle Capacity Pi
❑ Wean to Finish
12rwean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ 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?
innlatia
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
0
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes J'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
.j No
❑ NA
❑ NE
❑ Yes
."No
❑ NA
❑ NE
12128104 Continued

Facility Number: — -7 Date of Inspection 3 a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Jallo ❑ NA "❑ NE
a. 1f yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑-No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ,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 ❑-90 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �] o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,❑'PTO ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes FeMo ❑ 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 ,ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .B-To
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 0—No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ID No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[--]Yes allo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 41a7 9tl, ^ d8'
Reviewer/Inspector Signature: Date: � d 6
Page 2 of 3 I2128104 Continued

Facility Number: 3 i — 30 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JM No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. J Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall []Stocking ❑ Crop Yield 0120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ErNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes J014o
,E'?qA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[--]Yes [--]No
.f]'NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
C?NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes ,EJ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA � NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
qNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
j2 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
_E2 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
C'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
Page 3 of 3 12128104

(Type of Visit j0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number wry Date of Visit:
Permitted 13 Certified Conditionall Certified ' © Registered
Farm Name: _� !'.....L�.:1_-.��._.t�
Owner Name:
Mauling Address:
Not
Date Last Operated or Above Threshold: _ -.•
County: _ „ _ i
Phone No: _
Facility Contact: Title:. _ _ .. _. Phone No:
Onsite Representative:[ �!Yt - , , integrator -
Certified Operator:- - _-----_-_-------_-- -- -_ _-_- --- . , . _ Operator Certification Number.
Location of Farm:
L
Pswine U ouitry ❑ Cattle ❑ Norse Latitude • 4 Du Longitude • 6 �u
Discharges 8 Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes B'%Io
Discharge originated at: ❑ lagoon ❑ Spray Feld ❑ 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) El Yes ❑ No
c_ If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notifv DWQ) ❑ Yes ❑ No
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes -EIT40
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'Ja-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 'ErRO
5trrture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ..__ ._.... ..._-..-...-....-.._-- •-..........__..._. _--........._.. ........_..._ ....... .._.__
Freeboard (inches): _
12112103 Continued

Facility Number: -?/ T��� Date of inspection /s? /
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
,O'No
6. Are there structures on -site which are not properly addressed and/or managed through, a waste management or
❑ Yes.0 No
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 ,.BNo
S. Does any part of the waste management system other than waste structures require maintenancelunprovement?
❑ Yes 23 No
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ,E No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes aflo
I I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes )2N6
❑ Excessive PPoonding ❑ PAN ❑ Hydraulic Overload Frozen Ground ❑/Copper and/or Zinc
/❑'
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes 21'No
14. a) Does the facility lack adequate acreage for land application?
i
❑ Yes -0 No
b) Does the facility need a wettable acre determination?
❑ Yes 21'No
c) This facility is pended for a wettable acre determination?
❑ Yes 0.90
15. Does the receiving crop need improvement?
❑ Yes O'No
16. Is there a lack of adequate waste application equipment?
❑ Yes `0'14o
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes J2'No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes Z&o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes .13 No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes J:3 Flo
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
�IICPI
ReviewerAhspector Name V,
ReviewerRnspector Signature:
1".UlU3 lg71anuca

Facility Number: 73QQ Date of Inspection O
Required Records & Document.~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,ONo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑
Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes
❑ 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 �Io
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes -0 Nio
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ,El No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes .ENo
28. Does facility require a follow-up visit by same agency? ❑ Yes A No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ZNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes Z<O
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number
Date of Visit:WEE] Time:rQ l.J
/
Not O erational Q Below Threshold
Permitted M Certified E3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
L(d /
Farm Name: r► �� W'y County: 4joh
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative: 7G xArz- l'dw/l
Certified Operator:
Location of Farm:
Title:
Phone No:
Phone No:
Integrator -
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0° 0" Longitude 0' ' 0"
Design
wine Ca aci
Wean to Feeder r}
Feeder to Finish
Current Design Current Design Current
P,a elation Poultry Ca aci Po elation Cattle Ga aci P,o elation
❑ La er ❑ Dairy
❑Non -La er ❑Non -Da'
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts Boars
J[E
❑Other
Total Design C►apaClty
Total SS
Number of Lagoons � ❑ Subsurface Drains Present ❑ La oon Area
Bolding Ponds 1 Solid Traps ❑ No Liquid Waste Mana ement S stem
❑ S ra Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i
Freeboard (inches): /_
05103101
❑ Yes 91 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
KLNo
❑ Yes
%No
❑ Yes `9No
Structure 6
Continued

Facility Number: 3/ —3
Date of Inspection S Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AnDliCatiOn
❑ Yes ® No
❑ Yes Q No
❑ Yes �,No
❑ Yes X No
❑ Yes M No
10. Are there any buffers that need maintenance/improvement? ❑ Yes O No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 1�1 No
12. Crop type wa
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 5SNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes %] No
b) Does the facility need a wettable acre determination? ❑ Yes K No
c) This facility is pended for a wettable acre determination? ❑ Yes M No
15. Does the receiving crop need improvement? ❑ Yes K No
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 or other Permit readily available?
❑ Yes
V.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
C&No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
K No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
UNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
iQ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
OR No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Conements (refer to:question #) Explain any'YES ansUers and/or any recomm w ations.or any.other
JUse drawings of facility io 6etter explain situations. (use additional pages.:a necessary} T;
El Field Copy El Final Notes
F .
retoRd Ae•-e 4v.#4 --fie re4o'A- at
k Ale�:m I ok 6�4 �
Cork V0__
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: 31 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 Wo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes t9 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 J!9*o
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 ENo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ,PJ No
O5103101

Ihvis�on of Water quality . .
Q Deviston of Soil and .Water Conservation
Q,Oiher Agency _, • - - - .
4a `
Type of Visit If Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Q Date of Visit: I 11ZIA& I Time: 1I ! Printed on: 7/21/2000
Q Not O erational Q Below "Threshold
#Permitted ❑ Certified © Conditionally Certified [] Registered Date Last Operated or Above Threshold . ..................... .
Farm Name: .... .S t�n.�% .....44�427-/'......1..., + ..�........... County:....... �PL2N...........................................
....,, ......... .......... .........
Owner Name:.....,�I."l��i�10........1..1../1..........[N!.�..".... Phone No.......................................................................................
Facility Contact:
Mailing Address:
....... Title:
Onsite Representative: .........................................t
..... ......................
Certified Operator: _:::; �F��..0 �o�F
Location of Farm:
PhoneNo:...................................................
..........- ................ I ..........-......... .-......................... .........-................
Integrator: .....'/"*'* ............
Operator Certification Number:,
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• ��«
Design Current Design Current Design Current
_ry Ca Po Population Poultry -Capacity Population Cattle Ca Po ulatiop
-- Wean to Feeder Q ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
�? Other
Farrow to Feeder
Farrow to Finish Total Design Capacity
_ Gilts
u Boars Total SSLW771
� � pf gpp� f �❑ esent f j❑ Lagoon Area Jg Spray Field Area
PDadslSolid'Tra ❑ No Liquid d Waste Man' r
~� ps q 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/tnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier; .........................................................................................I..... ..I......
Freeboard (inches): 30
5/00
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNv
❑ Yes ANo
❑ Yes YfNo
Structure 6
Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes/No
8_ Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes )dNo
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 ❑ YesXNo
i'_
12. Crop type ' L/�%}iq-4 T!/.p� �, //1, !r/er1,1,0W:54EQ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�. i 4 Yi0f;a Qos.ot- 00riclend0s #*re po(e4 00ing Ns'visiti • Y:ojr wiil•teeoiye 4o futtbgr
co
r3resporidence about this visit ...................................
Comments oicer th question #) Exp1
Use-drd .._ of fkc ity;to".better ettpi
1q jyR� �a
MmNl
and/or any-recomimeadetions"o
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes �No
❑ Yes ?�No
❑ Yes No
/5
❑ Yes No
❑ Yes No
❑ Yes 5No
❑ Yes /VNo
❑ Yes VNo
❑ Yes,gNo
i'situatroris. {use additional pages. as necessary)
��A,,Ck 445 �is�,v ��� z M -pit/ 1b
1 VD7E i ! ��GDS �Vi4 DItJ Zon fw OQQ,
Reviewer/Inspector Name - s
Reviewer/Inspector Signature: ZZA Date: f'� 5100

L Dtvtston of Water Qu ahty3.
Q D�ns�on of Snit and -Water Cooservat�on s F
iz
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 'Routine Q Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: �L�Ex1 Time: `GV Printed on: 7/21/2000
3 0
Q Not Operational Q Below Threshold
[] Permitted 0"' rtified 13 Conditionally Certified 13 Registered Date Last Operated or above Threshold: _-_------------------
Farm Name: WG.1l�r- County:........1,�.... ...................... .__....._..._.......
Owner Name:... .................................................. .................. Phone No: CL4— -\d — d 1........
Facility Contact: ..............................................................................Title:............ Phone No:
MailingAddress:..........................................................................................
Onsite Representative: l. %D_,—
..^' ntegrator:......................................................__._.._.........•--.........._.................. .
Certified Operator: ............................................ .. ... Operator Certification Number:..........................................
Location of Farm:
W.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' Longitude �• ��°°
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder po JE1 Layer ____d❑ Dairy
❑ Feeder to Finish JE1 Non -Layer I I I[] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-nn Area ILI Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharves & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ix No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed: was the conveyance than-ruade?
❑ Yes
❑ No
b_ If discharge is observed. did it reach Water of the State'? (If yes, notify DI�i��Q)
El Yes
❑ No
c. If discharge is observed. what is the estimaied [low 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
kNo
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
b(No
Strucutre I Structure 2 Structure 3 Structure 4 Structure S
Structure 6
Identifier..................................................................................
Freeboard (inches): 3�
5100
Continued on back

Facility Number: Date or.juspection —J Printed on: 7/21/2000
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes �fNo
❑ Yes b�No
❑ Yes XNo
❑ Yes W No
❑ Yes XNo
❑ Yes WNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes PNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes k__,rNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18- Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc-)
19. Does record keeping need improvement? (ie/ irrigation, Freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yiolaitoris:or aefi.eie'nc�e5 were noted dirr�ng�bis:visit:- Y:op:witf-receive Rio further
I.-.,correm e' ' * ab' A this visit. ::::::: ::::::::::::::::::::::::::: :
❑ Yes ❑ No
Yes ❑ No
0Yes ❑ No
❑ Yes kNo
❑ Yes ONo
❑ Yes
0 No
KYes
❑ No
❑ Yes
hjrNo
❑ Yes
ONo
Comments (refer to question #): Explain any YES answers and/or any recommendations or any -other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes 'fNo
❑ Yes )RfNo
❑ Yes �(No
❑ Yes MNo
1 L ��Y1 1�%-�Y�f (J�-`� �,T • V j��� L'J I���-`.. Gym
-r�a t�.� �--a � Q►— �y _��,,t-.��o4'� ` h ti'C �r , G �
1 [�l•.J �i�2-��l Ito � '` .� W � ���1c"�� C►� I�G�S
hem,
t
Reviewer/Inspector Name
Ta—,gCt5 3Ct0U I;J, D�Dc
Reviewer/Inspector Signature: 1! . j Date: t 4 = `A_pp 5/00

Fadlity Number: —'36n Date of iuspection MPA-G-1 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 aWor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29; Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a peimanent/temporary cover?
❑ Yes �No
❑ Yes No
❑ Yes INo
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes allo
_bona -ornments and/or rawtngs:: -
—�x LZ'
J
5100

µ _ [3 Division of Soil and.Water Conservation'- Operation•Review =
-
• Division of Soil and -Water Conservatron .Compliance insp
ection t
Divisiomof Water QuaLty -Compliance Inspection
- - vrew. -Agency
te- s
,.
0 Routine O Complaint O Follow-up of DWO inspection O Follow-un of DSWC review O Other
I Facility Number I
© Permitted AC{e'rtified C3 Conditionally_ Certified © Registered
Farm Name: ....t]. ......... i(7,,C.. ...........
Owner Name.
........ JAM.. -CV eh.......... C JGI%�................................
Date of Inspection J ZY
Time of Inspection 24 hr. (hh:mm)
113 Not O erational Date Last Operated:
County :.....-b1-1Pk1.W ..................... ... 1 .
Phone No:.........`�Lz>��.....---...L�IJ..r�..2.317 .............
Facility Contact: ................................................... ..... Title:......................... ..... Phone No:
Mailing Address: ..............
Onsite Representative:......... !"Ptwb........ .irre
%' .f.l:...................... Intel;rator:.......... /.LI d',?�....................
I ......
I..............
Certified Operator:......, SAI-f SOR,b........... .... ......................... Operator Certification Number:........,.................................
Location of Farm:
f e ��C d —
.... P7 .....i'---..... --/� 1.....(0.........=......5 .....Q ....., .......................... :
Latitude 0 �' •�
Longitude •
�j°�
L
Design Current Design Current
==
Swine Poult -,,..
Ca acity Po ulation ry ` -Ca acity ..Po ulatiion ;Cattle _
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts i
❑ Boars
"; ❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
1 ❑ Other
Total DesignE Capacity
"-Totalssi w
Design Curreint
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area IDSpray Field Area
Holding Ponds? Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El 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 gallmin?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
W
/
Freeboard(inches): ............�.. .............. ......................................................................-............ .............-.................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes OKNo
❑ Yes P No
❑ Yes x No
Structure 5
❑ Yes X No
Continued on back
3/23/99

Facility: Number: 31 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes /6No
(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 O No
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ElYes No
Waste Application
t0. Are there any buffers that need maintenance/improvement? ❑ Yes *No
11. Is there evidence of over application? ❑ Excessive Ponding []PAN ❑ Yes 1kNo
12. Crop type 169 rM
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
t5. Does the receiving crop need improvement? ❑ Yes 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
I&
Does, the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
)J Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
0 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
El Yes
,{�{ No
(e/ discharge, freeboard problems, over application)
JoJ
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
j,No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
k' No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
R1No
yiQlA66iis:or• dfficie'ndbg -.WI* re noted• diW!hg �his:visit' - Yolk Will•reeeiye fW fuirther
• corresp"deixce' abouf this .visit.... _ .... .. . '
Com tents:(refer tug uestion #) Explain any YES aas viers and/or auy°recominerzdations or:any otliereomments
Use.drawings of facility to better explain situations (use addito_ nal-pages as-necessaiy)
/�• �o�c ems, uJ�Sr� ��m ��t? -�� �a/�-[.c� ors ��` G����
Ve-x r� )20 r 5,1IY1Pl e116 �7
7.�-e-7 P PI, lA✓ro e ht7_do.I
Reviewer/Inspector Name
Reviewer/Inspector Signature: 11-14A Date:
3/23/99

Facility Nurnberg- 5091 Bate of Inspection 1 2
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 AfNo
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
34. 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 Z No
3/23/99

t+Aa0 Division of Soil and Water Conservation 0 Other Agency
�mmE3Division of Water Quality
Routine 0 Con taint 0 Follow-up of DWQ inspection 0 Follow-up of.DSWC review 0 Other
Date of Inspection
Facility Number 3 Time of inspection o 24 hr. (hh:mm)
13 Registered 63 Certified 0 Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated:
FarmName: ...................... W.40.w...... kytx-................................................... County:---...btI,[i.K..................... I................. .......................
OwnerName: .....!s"A............ M,.... ....... WA ............................................. Phone No: .... (11.0.).2$.7- 73 :4.........................................
Facility Contact: ....... S-k.......... ... Title: ......................---.. Phone No:
MailingAddress:..... is Ji.�L......[ SS..... t !r C�,.. ........................................... .................................................... . 7 !%44 ........
Onsite Representative:. 5 41.11.11100�........................................................... Integrator:.......... ..
Certified Operator. .................................................. .............................. ..... Operator Certification Number, ...
Location of Farm:
gas rr .....; 5..... ......CS .....51�....1 Qr... . wiAL.0. .. I. :.......
...................... ............ .......... ........ ......................... ...... .
Latitude • 6 r_�46 Longitude 0' 4&
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
[R No
2. Is any discharge observed from any part of the operation?
❑ Yes
P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
® No
- b. If discharge is observed, did it reach Surface Water? (If yes. notity DWQ)
❑ Yes
[g No
c. If discharge is observed, what is the estimated flow in aal/min?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
IT] No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
(P No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
j No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97 Continued on back

acilih, Number: 31 — S4
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,lloldina Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Stnicture I Structure 2
Identifier
Freeboard (fty .......... U; Z................. .
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
......................................................... .............................
1 1- Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes �1 No
Yes ❑ No
Structure 6
............................................................................
❑ Yes [0 No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste Application
14. Is there physical evidence of over application!
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type...............�Rx:t►tao................................................St'tr*11-.-•...................
:.......................................
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?
M. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit"
0 No.violations or deficiencies were.noted during this.visiit.- .You.will receive -no further
correspondences about this'.visit
❑ Yes
W No
❑ Yes
CA No
❑ Yes
CK No
❑ Yes
04 No
....................................
❑ Yes FA No
❑ Yes D9 No
❑ Yes 91 No
❑ Yes ® No
M Yes ❑ No
❑ Yes No
Yes ❑ No
❑ Yes rM No
Yes ❑ No
❑ Yes ❑ No
Cotninents (refer`to.question #): ;;Explain any YES answers and/or arty recommendations or any other comments: '. }
[ 6 dirawings of faeilit-v. to better explain situations.'(use additional pages as necessary}
oa.. W.c i M V -4fr: vvk �-ec6&4 4�,00h (W ( StWO16 toe t awgv j M V%j
IN w 1^e5�tsnSi �'itvu�y 1hOtKttitt: zz. CGvfUlk t�'146 C4_CVCCjOjl SWJ be uSed i0, sp(o� yttotrk. CoraL Neffw aci-c-5e. shot��
be? v54 iix cohdw4,t) `, N'4rn U, oh fv'-m. tl/rlatk + Vi'-c SAOUIJ
TLO- iR�- 2 5YK0,11 yW%V\ 1&tVA 04el^f-Ch1CjC.t�il �,,,,� Sel, 74 �t.iiimiwJ ror`
Z4, VR�, co-crtc* LKQ attrca�e for Srns1t15 � co►1i rczul; %`vt avGrr��ktu'?)h at NJ
7I25/97
Reviewer/Inspector NamMIN
e'
L-
Reviewer/Inspector Signature: Date: ZZ)VIL

Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection z �}
Facility Number
Time of Inspection , 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr .15 min)) Spent on Review
® Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated:
Farm Name: ..........
county: ...34tp,-------
... __.....__.... _....__.... _.
Land Owner Name: _ �,.�. 1" �__. IAI ......... ..... _..... Phone No:
Facility Conctact:... Title: D Iti?AtdC.. _.. . CeV.a - .-.2u .�.�..._. .....__............................ ............_.. Phone No• .. *.... ._......
]Mailing Address: . ��a �.. ���?lc]�.SS... � .... l�G � .... _. �i?SR��j. �.�............... � . m........
Onsite Representative:..p ..R1fA .....�.... _..._T Integrator:
Certified Operator: . .. . .... . ... . .... _ . _ ........_ .. _.......... .._.._ .... _....... Operator Certification Number:
Location of Farm:
Type of Operation and Design Capacity
y{. J��zzgz
gn Current'Desgn Court ent ADes�gn Current
D.
. r� : ... Ca ace Po ulatian= Poultry Ga act rt.Po tilationCamel " ;Po "tilatton
Wean to Feeder�0 La w E]Dairy
[I Feeder to Finish ❑Non La er `, ❑Non -Dairy
rl Farrow to Wean &Nr
Y
Farrow to Feeder r Tvtal DesignCapacity ),60
Farrow to Finish
❑ Other
�9Numbe�of L gounxHv d g o�n`dsY❑ Subsurface Drains Present
x ❑Lagoon Area ❑ Spray Field Area
n ral
l . Are there any buffers that need maintenance/improvement? ❑ Yes IgNo
2. Is any discharge observed from any part of the operation? ❑ Yes [A No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes NNo
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ) ❑ Yes M No
c. If discharge is observed, what is the estimated flow in gal/min? Pr
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes %No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes PNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes `q No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes NNo
4/3 Q/9 7 maintenance/improvement?
Continued on back

Faci�ity Number:.......—.�..._
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding PondSj
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
: d......_. .......................... ...................
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?
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?
❑ Yes 5LNo
❑ Yes [TNo
❑ Yes K No
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, orrunoffentering waters of the State, notify DWQ)
15. Crop type ..... _....... _. ...y[ j
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?
or Qdfied 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 0 No
❑ Yes JR No
❑ Yes 1$ No
❑ Yes IS No
Is Yes ❑ No
❑ Yes ® No
Yes ❑ No
❑ Yes No
Yes No
❑ Yes allo
❑ Yes g No
® Yes ❑ No
5 Yes ❑ No
Comments, refer to uestron #) Explain any YES:answers'and/or'any reconunendations ar any other commeats:j
Use;drawings of facility to be(use additio tter explain situations: nal pages as necessary) r
..3>r
W C J"v- a o� rYe,y 564 %e, des, na�j ► n C
was 0­0 iW had" ks oLle) � q CA;Jm P.
VG4 b s Y'whm oex
Aez 41.�w .� S "OV13 (_OJ i.� h41r' r1V • C'& (k i YI'l A- 00 an;y' O Al cko' (r)
WM4 11�1 t Lf �DV1 �h �D i11d1 a �� S�y�,� Ge I Y11 oh 6� 4cr, ) O y� ej =
�' I 1
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

C
Site Requires Immediate Attention:
Facility No. /- ci
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �J �_ , 1995
Time -
Farm Name/Owner: gqn,
Mailing Address: ZZ IV--' &,42a- ��� , Wa. 11 a C4 . N I C` /
County:
Integrator- Q], - Phone:
On Site Representative: Tst-t?,, jj%n,-CQ W-b DtGy Phone: --7 3 77
Physical Address/Location: L- 2LV-'- Tom_ V _ v..•
Type of Operation: Swine' V*",- Poultry Cattle \14
Design Capacity: -42k.Q _ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 341 - 'f'/' a60 " Longitude:":Z 7' �' 3: ' -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) or No Actual Freeboard: _�?�Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or& Was any erosion observed? Yes or&
Is adequate land available for spray? or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility'meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells. Y�s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes N
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oz
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o Nam' If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No cra-x S r r -
Additional Comments: CP � 2 ers4 e
Inspector arne
Signature
cc. Facility Assessment Unit Use Attachments if Needed.