310312_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

(Type of Visit. O Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t p 1"? Arrival Time: ® Departure Time: � County: l UPCrJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: c ) C)1" o 4AA-ba:.S0,0 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: 1,30S7
Certification Number:
Longitude:
Wean to Finish
I Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
MDesign Current Dry Cow
lt , C_a aci P,o Non -Dairy
Layers Beef Stocker
TN
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
ers
Beef Feeder
Boars
Beef Brood Cow
Poults
Other I 1 101 1 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 -trade?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [] N
❑ Yes Ld 110
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

ility Number: - Date of Inspection: p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes environment
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes E(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 C;allo ❑ 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 Ca/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
[o
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Wo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
hio
❑ 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
[;�K0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio;�o
El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
WNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

IP%ility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FjNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ 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 �No [] NA
❑ NE
❑ Application Field Cl Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes La No ❑ 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 gNo ❑ NA
❑ NE
Comments (refer to question #): Explain any YES,answers: and/or any additional recommendations or any ­other comments.';
Use 4rawings of facility to better explain situations (use additional�oages"as"necessary)
Reviewer/Inspector Name: ',i 0
PhoneClio) 916-IA
Reviewer/Inspector Signature:
Date: ID
Page 3 of 3
21412015

Date of Visit: J Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �C' n ff'f t S� r1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Desiga Current
Swine Capacity Pop.
an to Finish
R'et Pointry
La er
Desiga
C+apacity
Curreat
Pop.
Desiga Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder &go 0
er
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
D , P,oul , Ca aci P,o
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts Non -Layers
Boars
Pullets
Beef Brood Cow
Qiher
Other
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes C]� o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
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 o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ YesgNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

F4cifi Number: 'j - Z Date of Inspection:
l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[—]Yes
[:]No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `-t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O-N—o
❑ 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
EfNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
CJ'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
F.10
❑ 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ NNo
❑ 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
[2 1w
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E]rN-o—
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t� l"'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
M No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes e'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EE[1d"6 ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Fa ill Number: Date of Inspection:
24. J)id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes , to ❑ NA ❑ NE
25. IS the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ETNo ❑ 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 0 Yes [rNo ❑ 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:
❑ Yes P No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [EYNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ ' o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [] Yes No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
C11V
Date:
21412015

Type of Visit: Q C Hance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 7 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: z S Arrival Time: Departure Time: q 2Q County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Tp h A f -I Rr1" s _D rn Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
4PF I
INon-Layer I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
DiF P"oultr,
C_a aci_
P.o
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
'
1. Is any discharge observed from any part of the operation?
❑ Yes
[� o
❑ NA
❑ NE
Discharge originated at: D. Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ff No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili dumber: 'aj - Date of Inspection: f -"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes El -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑/ NNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes Q o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
,-�
❑ Yes E No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ef 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?
o
❑ Yes f�tNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes PVN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes []�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E:fNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ONo
❑ 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 gN�o6
NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection: z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El -No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [91No ❑ 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? 0 Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [ 1 A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals"with 24 hours and/or document
❑ Yes
2<0 ❑ 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
EfNo ❑ 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
[2'1`lo ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below.
❑ Yes
ErNo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q.?-To— ❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No❑ NA
❑ NE
Cominents'(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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: <) I O 6 7 3
Date: 2
21412015

psi r n S­.�. a r
Type of Visit: QfCo ptiance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 7outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: j Arrival Time: Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 1_� Zk l
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Design C►urrent Design C►urrent
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La er Dai Cow
Nan -La er Dai Calf
Y.
Feeder
o Finish
Design Current
D . P.OUI .. E - aci_ Po
Layers
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
o Wean
o Feeder
Farrowo Finish
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
M No
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesVN0o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: IDate of Ins ection: 11 L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: GO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
jjYes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
l threat,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm71�
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yeso
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 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
VNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes 0
[:]Yes A
[:]Yes 1 rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [✓] No ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
❑ Yes g
�❑ NA ❑ NE
YesNo ❑ NA ❑ NE
❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �XNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ Ni
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 4 ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes
❑ Yes
Yes
❑ Yes
❑ Yes
EJ/No
❑ NA
❑ NE
/No
NA
NE
NA
❑NE
;No
NA
❑ NE
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.° ;
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone:�g1 j} 6 " D
Date:4/111/1
2/4 Ol1

(Type of Visit: (Q Co Hance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: E;R_outine 0 Complaint O Follow-up Q Referral Q Emergency O Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time:® County: i { Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative:
Integrator:
Phone:
Certified Operator: Certification Number: j a
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
X
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder t7
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer D ' Cow
Non -La er EADai Calf
Dairy Heifer
Design Current Dry Cow
l Ca aci P,o , Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
[—]Yes ❑ No
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 31 - 2— Date of Inspection: I I
Bit ,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? [:]Yes [-]No
❑NA ❑NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&,suK
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [2 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesYNo
o ❑ 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 dNo ❑ 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
CNo
❑ 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
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dN0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CdNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �iNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F2/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3k Date of Inspection: 3 t l3
24. pid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA FINE
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 6 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes &No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes C?(No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes [3/No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ No
❑ NA
❑ NE
o
❑ NA
❑ NE
fNo
❑ NA
❑ NE
&No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations.or.:.any, other comments
Use drawings of facility to better explain situations (use additional pates as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qlr,
Date: 3 3
21412011

(Type of Visit: ©VRoutine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
isit:Reason for VO Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: it Arrival Time: � Departure Time: O County: o? Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ►J
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop,
La er
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
bb
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Curren#
I) , P,oult . C•_a aci P,o ,
Layers
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharp-es 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 D /No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑NA ❑NE
❑NA ❑NE
❑ Yes ❑ No❑ NA ❑ NE
❑Yes VNo
❑NA ❑NE
❑Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciH Number: Date of inspection: 11 46
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1J
Identifier: �1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 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 environmentpl threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes j(N 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 o ❑ 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[]Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
YNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
[No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[(No
❑ NA
❑ NE
Rguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
F�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 ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q- o.
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;,;�o/
❑ NA
❑ NE
Page 2 of 3
21417011 Continued

Facile Number:31- Date of Inspection: It i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M VNo
❑ NA ❑ NE
25. lsthe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 [ Flo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
Or'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0
❑ NA
❑ NE
34, Does the facility require afollow-up visit by the same agency?
❑Yes
No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as. necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
!Q R_ L - Phonegl_0
qcf4a".Idl) Date: i I (a 7/
21412011

rT
ype of Visit: Q Cq(npliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
eason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ib I Arrival Time: Departure Time: 93v County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
OnsiteRepresentative: � 014►1 14A201y'4 Cf2. Integrator:
Certified Operator: Certification Number: IlRos 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current Design Current
C►apacity Pop. Wet Poulii—Jacit-VINR.
Cattle
Design
Capacity
Current
Pop.
Wean to Finish
-��
La er
Dairy Cow
Wean to Feeder
00 -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dr, P,ouitr, C•a aci P,o ,
Layers
Dry Cow
Farrow to Feeder
Non-Dai
Farrow to Finish
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharmes 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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes WN
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Yes o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: Un, -cl{ ti
Waste Collection & Treatment
4. Is itorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LDJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CA C-00 rJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes dNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen
,tpl threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Fd'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 2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes deNo ❑ 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 ❑ Failurc 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
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
d�qo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ 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 ❑ 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
0 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
rl l J
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJ No
❑ NA
❑ NE
Page 2 of 3
214120II Continued

Facili Number: - l2 Date of inspection: 1012,'gla
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes 2 (1�e❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesVNo❑NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WNo ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes E2/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 [;Y/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ]/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes [J 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 04)
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes F2/No
❑ NA
❑ NE
Reviewer/]nspector Name: Jo i{ iJ t-t'1 at j Phone: �9�� r (C — -73 7Y
Reviewer/Inspector Signature: Date: I b /Z-V %.
Page 3 of 3 21412011

.a
31 M. 3 (:�-
Type of Visit 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: S Departure Time: County: DUD Region:
Farm Name: o Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: }- Title:
Onsite Representative:y640 ` Aywzso k�,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
0 0 A Longitude: = ° = , = "
Design C►urrent
Design
C►urrent
Design
C*urrent
Swine
Capacity Population Wet Poultry
Capacity
Population
Cattle
Capacity
Pop ulatiou
❑ Wean to Finish ❑ Layer
❑ Dairy Cow
,Wean to Feeder
6v IS'af, I I0 Non -Layer I
1
❑ Dairy Calf
® Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
❑ Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cowl
I
❑ Turkeys
Other ❑ Turkey Poults
❑ Other 1 10 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes d No ❑ NA ❑ NE
❑ Yes ❑ No []NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA [I NE
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes [2(No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 31 - 3 11
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structur 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA=
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 6 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ 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)
I4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 NN ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
Q ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
7/No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
YNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No ❑ NA
❑ NE
Comments (refer to question'#): Explain any YES answers andlor.any recommendations ,or -any other comments
Use drawings of facility io"better explain situations (use additional pages as necessary)"
Reviewer/InspectorName rk�t,U..: Phone:
Reviewerllnspector Signature: 4a _A.D7, Date: 11
»ran ini �+___�•_____a
ruge c vJ .3

. f
Facility Number: — 31�j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ilNo ❑ 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
p El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
[/No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
� o
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
2No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[/No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[Z�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E2(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
dNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E&
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative -immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
U�]No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional -Comments. and/or Drawings:. :"
Page 3 of 3 12128104

37Z
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Ernergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: -� ` Title:
`1 Onsite Representative: ° Aid A/AKk eaJ
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 0 0 6 Longitude: [= c= i=
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poujj
ltry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
Wean to Feeder O a t?
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Non -La ersPullets
❑Beef Feeder
FEIGilts
Boars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 1J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N
❑ NA
❑ NE
El Yes
No
[I NA
❑NE
12128104 Continued

r
Facility Number: — Date of Inspection °
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
lI
Identifier: LA �`�rl!
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes o
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes No
❑ NA ❑ NE
through a waste management or closure plan?
eat,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta7No
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes YNo
❑ 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 ENo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [?fNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes jZrNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No [INA
[INE
15. Does the receiving crop and/or land application site need improvement?
ElO Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[VNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ql ❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ILJ Zo ❑ NA
❑ NE
;Comments (refer to^questton #) Ea�platnrany YES answers and/oraanyirecomEtiendahons or anv ntier comments y,"s n*..
.� :..�t v �-._ ,»�,,, `'t?*i*g' tea,:-, .:k°°� •`Ryd k"e^,
:Else drawtngs:of facility to better e:eplain.situahoiis (useadd�honal pages as gecessary) �. �: t ..�� ,�. K
•
ReviewerlInspector Name Phone: 3
Reviewer/inspector Signature: Date: s
r

Facility Number: — Date of Inspection
_Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes di, o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 7No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[/No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
InspectionfNo
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9�O
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
6<.
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
L
[INA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CJ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E(No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IQ o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
I2128104

i H 3I2
Type of Visit Ortom liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint Q Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D
S S Arrival Time: �� Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Phvsical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 1 = Longitude: = ° = i ❑ it
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Other
❑ Other _ T
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daity Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef feeder
❑ Beef Brood Cowl
Number of Structures: =
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
❑NA
❑NE
El Yes
El No
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes ER N' o ❑ NA ❑ NE
12128104 Continued

Facility Number: 31
Date of Inspection
'VV,aste Collection & Treatment
ZNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LA6. cO
Spillway?:
Designed Freeboard (in): 19 S'
Observed Freeboard (in): Li Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(iel 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
E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[ 'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J Nc ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
Cl Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
nnGo�
13. Soil type(s) (`AttJS R k) y {mod
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
l_i o
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
IJ No
❑ NA
❑ NE
16. Did the facilityfail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LdNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
..:- �� .
Comments (reierto questzon�#I)'ExpIam an�YES answers and/or anyrecnmmendatioris or any other comments.
Use dra�wtngsoffactl�tytto better eaplain�sttuations�(use additional+pages necessary):
• F.
r2tN. n ,{�' � L° fL�
Reviewer/Inspector Name p Q� . V` f Phone ID �j a — 65
Reviewerfinspector Signature: Date: S1 T10 hnida
12128104 Continued

Facility Number: 73 1 — Date of Inspection o
Re dired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ 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 appropirate box.
❑ WUP ❑Checklists ❑ Desi n ❑ Ma s ❑Other
g p
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VINo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ET'No
❑ NA
❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C34o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
EaNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ o
El
LJ NA
El NE
26.
Did the facility fail to -have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
L'NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
�,/
1/J No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ETo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
[IN/co
LI'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
�iddrtiu�al CoiEiments'andlor
I2128104

[Type of Visit WCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility NumberDate of Visit: 0 e:
Tim•�.3
rM Not Eerational Q Below Threshold
PermittedJ316ertified [3 Conditionally Certified 0 Registered Date Last Opp norbove old:
Farm Name:
1�1 Y1� . r County:. r . .... _ . .
Owner Name:
Phone No: _ ... �.
Mailing Address: . » .. _ .. . . W . _.. _ _ .....____— » ...
Facility Contact: .. _ Title: . _
Onsite Representative: — faj us ot. . Z jc ._.
_ Phone No:
Integrator: ���A
Certified Operator. _ _ ... _-__--__-_ -_--` Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • u Longitude • 6 «
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes.-ffNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ,BNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ice` " o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

lFacility Number. -- Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes '01FO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ YesAn-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 maintenance/improvement? ❑ Yes ..,ErNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ..!fNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �No
elevation markings?
Waste Avulication
10. Are there any buffers that need maintenance/improvement?
❑ Yes Li! No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ yes [INo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop Jr
type
13. Do the receiving crops differ with'iKose designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes . o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes EjNo
b) Does the facility need a wettable acre determination?
❑ Yes .ZTNo
c) This facility is pended for a wettable acre determination?
❑ Yes . moo
15. Does the receiving crop need improvement?
❑ Yes O fqo
16. Is there a lack of adequate waste application equipment?
❑ Yes R No
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ yes �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 NNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
,I,
[IE Yes rNo
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 CWo
Air Quality representative immediately.
r �-c --...._. r—
:Co refetrtaquon, Fsplsm arq'YES answers andfar a or`any otl'Taomiaen4s. ry sri
kUse _ of Ito better s}mzti uu a>i as
o y otes �.�
P G
7R7
Reviewer/Inspector Name a� :� =
Reviewer/Inspector Signature: Date: C7
I/W9/UI conunuea

Facility Number: L7Date of Inspection
Reanired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes E[No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ,moo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes .Q-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes awo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, hwboard problems, over application)
❑ Yes .EMo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes J:jNo
28. Does facility require a follow-up visit by same agency?
❑ Yes E?No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes .13-No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes L1Qo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
3) ?Iease. bask dG+C- car oc-jober waste
Gna! s i s -For -(-1vz 5ep4-ey?n1oe,,
eve-yl s co rrec+- z1V2_1-J1P1_
lC1seC� 6�/oY wif,�'�� 5 2�
A a'A-7 ,c—ce2�oo
12112/03

W' .t•'b�vrsron of Water Quality
`t 01)iviston of _Soil and Watei: Cgnseiation . z
A,
OthEr genCy
Type of Visit oCompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Uatevf Visit: j 2 i?� Time: j Printed on: 7/21/2000
Facility `umber 3 ] Z
--- 0 Not Operational 0 Below Threshold
,Permitted 0 Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .......................
Farm Name: T h n �p.r'�t SA✓� �r
c! d ................. County: ........l��/-�!........ *.........
.......--........
.
Owner Name: �d ! S
.........Uj�........
...GS.............by'..�............-.--........-................. . Phone No:.....-....
Facility Contact: ...•Title. Phone No:
MailingAddress: ..................................................................................................................... .....-----.--..............................--.---..-............................
Onsite Representative:✓---e'hy% ��' xCh�� � h �'{��e��' ntcgrator: ................. . h
.............................................)......---.----.---...................-..-...
Certified Operator: ................ Operator Certification Number:
................................... .............................................................,._.................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude t 4& Longitude • 4 "
Design Current
.. Cana A v iPonullatian
- _ Wean to Feeder
Feeder to Finish
Farrow to Wean
y Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design :.. Cti'i - t
Poultry CapacityPo ula ation Cattle .. .: : Ca t '_ Po ulad 66'
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
um�a w Id
U'l;agoons f Subsurface Drains Present Lagrwn Area Spray Fie Area
_oltding Prods / So1xd Traps No Liquid Waste Management System �}
Discharges & Stream Impacts
i. Is any discharge observed from any pan of the operation? ❑ Yes j2rNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes JVNo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes 2rNo
c. If discharge is observed. what is the estimated flow in gal/min? in A
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes VNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes )zNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: .............. .....................-................ ..............................._............
..............................................
Freeboard (inches): 1 +- z
5/00 Continued on back

Facility Number: 31 — 31Z.]Date of Inspection I 24
5' Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0"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 '10 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? []Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ANo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes WNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes JUNO
12. Crop type Corn, W kCA _<a be q h s
13• Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes fa•No
16.
Is there a lack of adequate waste application equipment?
❑ Yes jVNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes gNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes gNO
(ie/ W1JP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ONO
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes ONo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(iel discharge, freeboard problems, over application)
❑
'0 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 51T10
24.
Does facility require a follow-up visit by same agency?
❑ Yes ONO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yesj2rNo
YiQI itioijs.e dgfieie>;cie vt re pQYe 11H°ig this;visit: Yoh will ><ec¢iye Q fuitiig : :
..•corresnotideace:abotit:this
visit:-:-:-:-:-:::.•.•.•....:•:-: .............•:•:..
14. Need U•e4QUe ,wei Ca IGvi.ct 10-X <kee4s W�lck _ h(kew 1-)OL) acirea eS `
w��e de-{t✓ftir;,�e�(_, vteeD� 1 Q !ems , 1..1 d4U, A rc qnJ jes e+6..ForePJL
j l , k,-C - k0-<e i n r�eCO ��.
P 1°
IV a-fe :
Reviewer/Inspector Name N''
Reviewer/Inspector Signature:
5100

Facirty Number; Date of Inspection 2 OZ 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 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 j No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes cno
roads, building structure, and/or public property) //
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ZNo
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 ,ErNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes /0 No
32_ Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additionad Comment&andlur Drawings
A61
J
5100

© Division of Soil and Wate7r C6nservation - OperatiomReview
= Z. _ ©Division of Soil and,Water Conservat,on -,Compliance Inspection „
Division of Water (Zual�ty =,Coua Ranee Inspection
w
p'Uther Agency O erat�osn Review
p
y,
59 Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
© Permitted © Certified © Conditionally Certified E3 Registered JE3 Not Operational I Date Last Operated:
..........................
�us�+ _
1 - .L.. .Q C1. -- Co y� �.L F..C�.L r.1......
Farm Name: i..h.� 1.....�ci A- L..r ........�...r..._.... Cam...
.......... ............. .....
Owner Name: ..T.L i.i 1......lr.A�.1�..�..�-.-..}... �L� ........... Phone No: Q..�...---. Z ..........
cJ {�-,.
Facility Contact: ... ....... Title: .i iZ... .................. Phone No:
rV1-L..........
Mailing Address:. �.. ...... -1..1.E ...... C HoGZla,- �......... ...................
............... '..Lk..�..y-
Onsite Representative: J-. r Z.....]� .I�,,..�..�... Integrator:..? �, ... ...............
Certified Operator:+.�-j..�.......................... � } �� [} rj f Operator Certification Number:..t. .�•...........
. ... .
Location of Farm:
ra�afMa....s.::..................1.1c�..,.....G.:.o.....�. 3.. k+n......:�z.....5[.l.L_o.......`LA...n.....................
..fC-SIT......C.._.o.....o.....C1..... !....... .... K.AT-)L .L-)L1.5t,=).-<,-
Latitude ` �� Longitude 4 • �° FCF�11-
Design Current::' ; .; Design
-Current _=_= Design Current
-Swine
PopulationPotlry. Capacity
CtlCapacity Populaton-y at •..
Wean to Feeder
t ❑ Layer
❑ Dairy
=�= ❑ Feeder to Finish,
❑ Non -Layer
�;, ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity 2
-: ❑ Gilts
_.
❑ Boars
TataI.SSL W
�Nuutber of Lagoons, _ ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
7:17Holding Ponds`/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated ac ❑ 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. Dries 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 ! Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ....... c..}1............ I .... .
❑ Yes KNo
❑ Yes XNo
❑ Yes qNo
❑ Yes K10
[]Yes o
❑ Yes o
❑ Yes No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/9
❑ Yes ONO
Continued on back

Facility Number: - Date of Inspection
0 q�
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes `I 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 gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
[]Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes No
12. Crop type C�_C7 1Q ( H 51 A�X: C:1L-r' n 5_At-n 12huC:M!g=l Q
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 RIN0
b) Does the facility need a wettable acre determination?
❑ Yes �4140
c) This facility is pended for a wettable acre determination?
❑ Yes %No
15. Does the receiving crop need improvement?
❑ Yes o
16. Is there a lack of adequate waste application equipment?
ElYes
zo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes `No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ,VrNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes TNo
o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes XN0
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems; over application) ❑ Yes E2"No
23. Did ReviewerAnspector fail to discuss review/inspection with on -site representative? ❑ Yes N0
24. Does facility require a follow-up visit by same agency? ❑ Yes $�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONO
Kk NO -A61.aWFrft.rj.d.ehtks...h6.fed- dt* 'ing this'visit' • Yoit :will•i-eegiye Rio fu 4.l er
corresp oridence'. abauk this :visit:. - . -
Cormnents=(refer to.gif &n•#):: Explain any YES.a'hswers and/or'any-recommeridations or any ot6er,commentsc-
.
Use.dirawinkss of facility to;t etter explaiii_situations (use addid6halLpage-s as, necessary} - _- -
/y G—t�—�D CAA rC_ E-i S4�L1 �t2 — •
A o �Q S n oT S A trd rz G- C) U -17-�hr '1�, t I�
C_
H 1Z t t _L_ `t7 /A,`r-C_ i�4
IReviewer/InspectorName F7-1_`
Reviewer/Inspector Signature: t-j- A r- A A , ,A 1 r -A a � A /,--I Date:
3/23199

Facility Number: —
Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
XYes
❑ 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
XrNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
XNo
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
XNo
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
; NNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
KNO
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
XYes
❑ No
Ad ,ih�Oomments and/or Drawrngs
sty I. 15a
t-•a3 A L—%—R G
CrV n--S
Nay 1I.
�--x t -r- 3 8 4--
Z'1nT�
4-O
T
At
3/23/99

€•t�
❑ Division of Soil and Water Conservation ❑ Other Agency Z_�
Division of Water Quality
Routine O Com taint O Follow-up of DW ins ection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
13 Registered CetSrtified © Applied for Permit 0 Permitted E3 Not O erational Date Last Operated:
Farm Name: Jari w r .... County:......�.YL,..................... .......
Owner Name: .......................d►............nYll.�u?�.?�:.................... Phone No: (`1.,ifE}.1,�'.:�.�Z�.... r.... ......... ....................
FacilityContact• ............... Title:................................................................ Phone No:..............----.................................
Mailing Address: ............ 41. ......h:4 ..... stf i..!�,........................................ ........... rP.ls�,t!......
t.,.N �. ................................... . 2.�.��......
Ortsite Representative: ..............�ak,.........J[i -X` (sp.n........................................... Integrator:..j...t�17�!.............................................................
Certified Operator................................................................. Operator Certification Number.........................
Location of Farm:
-'�..._t?u: .Si:.p...Q.........5 .....t 1....ha►. ....Ut A..:4......... (i.:...................................................................................
..................................... ..... .......................................................
Latitude O'40i' Longitude 0•6064
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes P No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes R No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 10 No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Ep No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require $ Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes q No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 1A No
7/25197

Facility Number: — y
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsAolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes P No
❑ Yes (2 No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 - Structure 6
Identifier:
Freeboard(ft):................l.:.................................... ................................... .._........................................---......................--.................................
la. Is seepage observed from any of the structures? ❑ Yes [P No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 19 No
12. Do any of the structures need maintenancelimprovement?
(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 ApRlication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type...........C.10ra................ L.t.1.h.t,ti_f.......
sa
�4 ....................---.....................................------.....................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0° No.vialations-or. defi:ierrcies.were-noted-during this.visit., Yodwill recei've�rro•ftirther•
: corrOsObdebce 4 ou. t thisvisit.:::.:::. : : :
1P Yes ❑ No
❑ Yes [DNo
❑ Yes 0 No
❑ Yes [%No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes] No
❑ Yes W No
Yes. ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
'F(.-x teas e 4,tol J be rrwvec a r cJo�y jpvd , �Min a_Sc a C _ a � d �sco�, Luc t ; ►�
ZZ• �. C.t,rrcc.-� �� N i o��x� �-�- s�o>,l� fie, �o�-I.c.d ; r`--�l„��5� t-�c,vrc�s.
s be s ")Jf I �5; co�nrcc c�ttic
► s�r�,� mcords ko Y ( y ! '� k u9
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'�" ( ►SarS {�,y-�il'� ` 4' E[s o � d�Vi
T
Reviewer/Inspector Name'
..
Reviewer/Inspector Signature:
Date; 31

Site Requires Immediate Attention:
Facility No.
�" z�8
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _, 1995
Time: r
Farm Name/Owns
Mailing Address:
County{
Integrator: Phone
On Site Representative: Phone: 2$�
Physical Address/Location: ��5� 1 �S`C7 q. gyp X o m.d -p�St / -Ac
Type of Operation: Swine - t-l" Poultry Cattle wt S .
Design Capacity: !�2_.t, LX _ Number of Animals on Site: 'J
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: L` " ' Longitude: -77_' "S-9 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) rNo Actual Freeboard: �Ft. IncitesWas any seepage observed from-theYes or� Was any erosion observed? or No
Is adequate land available for spray? 0e or No Is the cover crop adequate? 'e or No
Crop(s) being utilized: �1�c .an n
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(Xje- or No
100 Feet from Wells? IfGorNo
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes qPdo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line?' Yes or Vo
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar manmade devices? Yes If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific" acreage with cover crop)? Yes or No
Additional Comments:-... OTCmv, AA t vi Vern !s-r.P(r//1 V _ /Q
Inspector Name
cc: Facility Assessment Unit
Signature
Use(Attachments if Needed.
/_7

Site Requires Immediate Attention: .
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD + Z.
DATE. �" , 1995
Time: "S �YD—
Farm Name/Owner: _ �ib? �q .4 Qit �srnn J-
Mailing Address:
County:
Integrator.
On Site Representative:
Physical Address/Location:
Phone:
Phone: _ — 3 St 7a
D . 9-
Type of Operation: Swine ✓ Poultry Cattle . q LC'g,
Design Capacity: _QL4o - Number of Animals on Site:
DEM Certification llNumber: ACE DEM Certification Number: ACNEW
Latitude: �" `7�'�" Longitude: �7 ' Q Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6 or No Actual Freeboard: 6�_Ft. 1� Inches
Was any seepage observed from the lagoon(s)? Yes o6 Was any erosion observed? es or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: ! rr7 v1 *- U-) i� $t
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Xis or No
100 Feet, from Wells? 6s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orl�
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o6' If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with covercrop}? �.or No �
Additional Comments: [ �n . f1r� ► Vk h/n a. c. �-e
'6Iek
0 &exl�
Inspector N '
cc: Facility Assessment Unit Use Attachments if Needed.