310313_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

IJ
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: 1 County:
Farm Name: q Owner Email:
Owner Name: _-.l'Q�M j z. j2ai Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Region: W 1 M
Design Current Desigu
Swine capacity Pop. Wet Pointry Capacity
Wean to Finish La er
Current
Pop.
Design
Cattle Capacity
C►urrent
op.
DairyCow
Wean to Feeder
Non-1.a er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
lfi. Ca aci
Layers
f7_
Current
P,o
Dai Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
ers
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [Q.4416 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [—]No ❑ NA ❑ NE
[:]Yes [B ❑ NA ❑ NE
[:]Yes ��O_
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facili Humber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in); � a5
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 [� ],lam ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ©'No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑-No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [g-No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers; setbacks, or compliance alternatives that need ❑ Yes [ o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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 C9 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable Yes E2-lTo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E]Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EIo
❑ NA
❑ NE
Reuuired Records & Documents
N. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EoXo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑-f o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ o ❑ 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 Flo ❑ 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 21412015 Continued

Facility Number: jDatc of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑.Dlo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E o ❑ NA D 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 �Ko ❑ NA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Eg�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
g-lqo
❑ 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
E].NIo
❑ 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
ED 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
[]-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
[�'No
❑ NA
❑ NE
Comments (reefer to yuestioa'#) Explain any,al'ES answers atidA *0'sidditional recommendations o6any other:commeiits, g..
._ kY `. , .,`Sete � 1 . �F.' i�.. ]`' ga&�' ius"Pr`a'aW.mAsTof faeility twlb'V er explain;situations.§,[use additional pages as,.,itecessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/ VS e � /70 U i►'I�/� % l/ ham. 7`��
D V� Phone: To -7q6 -732
Date: a SI
21412015

Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: ( IWoutine 0 Complaint 0 Follow-up 0 Referral ( Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: �l �t Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator: Ila
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design Current
Swine Capacity op.
Wean to Finish
Design Current
Wet Pouitry Capacity Pop.
Layer
Design Current
C►attle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer I
EE
Dat Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
I Ca aci P.o .
Dry Cow
Non -Daily
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 )2 No ❑ NA ❑ NE
❑ Yes 6No
[-]Yes KNo
❑ Yes _EEj`No
❑ Yes ZNo
[—]Yes ONo
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑_NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

13 1
Facility Number: - Date of Inspection: I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes _C2"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 J2'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes J'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 2�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 F-y1Qo
❑ NA
❑ NE
maintenance or improvement? 7
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 _Callo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,Ea'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ❑�No
❑ NA
❑ NE
acres determination?
7
17. Does the facility lack adequate acreage for land application?
❑ Yes L2-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E5"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes ®.No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [-]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [a -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes j;?'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes ,Q�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacHity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z-No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J!fNo
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:
❑NA ❑NE
❑NA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �f o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �' o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C;jNo ❑ 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 ,Ef'-No ❑ NA ❑ NE
❑ Yes J�!rNo ❑ NA ❑ NE
❑ Yes _L2No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes LZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �T]No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �2/N o ❑ NA ❑ NE
Comments (refer to question #): Exptain any YES: answers and/or any additional recommendations or anyother comments:°
a
Use drawings of facility to.better explain situations (use additional pages as necessary).
/YOUC,S- h 40cle be
ei,7 ee%'1o1
be SCl re lo LL w
cp O lA re
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1/0 7f, �7_-3
Date: % ,k
214 015

Type of Visit: ,Q-C—ompliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: O'Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Od Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Region
Design
Curren#
Design Current Design Curren#
Swine Capacity
Pop.
Wet Poultry Capacity Pap. Cattle Capacity Pop.
Wean to Finish
Layer DairyCow
Wean to Feeder
LANoniLayer
I E] Dairy Calf
Dairy Heifer
eeder to Finish
U
Farrow to Wean
Design ur en Dry Cow
Farrow to Feeder
D . P■ouI C►_a aci P,o P. Non -Dairy
Farrow to Finish
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Gilts
Boars
Turkeys
Other
Turkey Poults
OtherFTOther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ;3No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes E!(No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes dNo ❑ 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)
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
❑ Yes �' No
[:]Yes [Ilo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

[IF"ty Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ja No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PVNc, ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes gNo ❑ 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 eNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PrNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E` No ❑ NA ❑ NE
maintenance or improvement?
Waste AnnllCation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ca�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
o
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
F'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes j Ab ❑ NA ❑ NE
Reauired Records & Documents �"
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L3'No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Jallo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
JZ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[;rNo
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Faciltty Number: - Date of Inspection: 2-d
• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 'zNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [r No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ 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 XNo ❑ 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 6o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes dNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [—]Yes /�No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) j
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[I0
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
r
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑f;�a 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
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any other comments. .
Use drawings of facility to better explain situations (use additional pagesas necessary).
f cq een,-,a- ,r' e c a e -d s loo-`C jc9fW
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
I
Phone: ?l�j7l
Date: ! 3 c) f
21412014

Type of Visit: O'Compliance Inspection U Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: p Departure Time: County: Region:�_41:14
Farm Name: f s�'i Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
&tl6z
Certified Operator:
Phone:
Integrator: Ze
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry Capacity Pop. Cattle
JLayer Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I
INon-Layer
I EE Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
D . P,ouIt , Ca aci I;o P. Non -Dairy
ILavers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Imoacts
l . Is any discharge observed from any part of the operation? ❑ Yes Feno ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes 6 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes 'ZNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
ff No
❑ NA
❑ NE
[:]Yes
2f o
[DNA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: 21- Date of inspection: Z
Waste Callection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [;�t_No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 2,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
[3 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
rr
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes JZ'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 Zf No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes C21'�o
❑ NA
❑ NE
maintenance or improvement?
I L Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �2'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 fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes E5No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes C;j"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes JZ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ZfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes `(] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ErSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JZ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jZrNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Ins ection: z7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;�rNo
25. Is tote facility out of compliance with permit conditions related to sludge? If yes, check Yes ff No
the appropriate box(es) below. 7�-
10 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 ZNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0No
Other Issues
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes VNo
❑ 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 Pr
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
7r
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 �qo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Ef No
❑ NA D NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �No
7�"
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facilitv to better explain situations (use additional Dazes as necessarv).
V1113 If 7 (/ t1 tss ea S "-e
A,- o?o f Z_ , 6,- 4S cr
G� a n e 114 /,-r- Yea /�
l2 -�-4' Ced CQ �I Gov
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: L Date: / Z7
Page 3 of 3 21412011

Type of Visit:__E�t'dmpliance Inspection 0 Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: JIAb Arrival Time: I Wd/ JZDeparture Time: County: Region:
z Aa�v
Farm Name-.___, 4 _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
44z 44z-
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator: ! gg S z�
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
We# Pmpg
oultry
La er
Desigu Current Design Current
Capacity Fop. Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oult ,
ILayers
Dairy Heifer
Design Dry Cow
Ca aci P,o P. Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Ef No ❑ NA ❑ NE
[:]Yes
P^No
❑ NA
❑ NE
0 Yes
qNo
❑ NA
❑ NE
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 EfrNo
❑ Yes ONo
❑ Yes j� N
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: Zo
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JD'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: jJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes p'!No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes /ffNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes _kTNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes P'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 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
elo
17. Does the facility lack adequate acreage for land application?
❑ Yes 0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,En"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes ONo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes eNo
❑ 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 D No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes WNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:l6 30
24. pid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 9No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ff No ❑ NA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ',.0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
P
❑ NA
❑ NE
❑ Yes
J�yNo
❑ NA
❑ NE
❑ Yes )2-No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes PNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes P�No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or -any additional,recommendations or: any other comments: y p y
Use drawings of facility to better explain situationsluse additional pages as necessary).= m
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
yy
Ce co'ds
Phone: :! 7�( -7
Date: !C
_> '13142
2/412 1

_. Um elf,
I
pion of Water Quahty
Type of Visit 101Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: G Departure Time: County: � Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
a�3=—Cm Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
lt.
Certified Operator: Operator Certification Number: �73
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= Q = = Longitude: = o E_-1' =
Desk n�+ CUCCenta�� ,DeS U .. Current �k Desrgn Current
Swine '�_ Ca aci Po 'ulation Wet Poultry "Ca a> Po`"tilat�ow—Cattle n C
h' P P t}' P apacty,opula ion
❑Wean to Finish = ❑ Layer
' ❑Dai Cow
❑ Wean to Feeder ' ❑ Non -Layer ❑ Dairy Calf
❑Feeder to Finish ❑ Dai Heifer
❑ Farrow to Wean: ❑ Dry Cow
Dry Poultry
_.�.a
❑Farrow to Feeder � "` � ❑ N on-Dai
❑ Farrow to Finish ❑ Beef Stocker
❑Gilts ❑Beef Feeder
❑ Boars
❑ Beef Brood Cow
❑Other mbe� of Stru"ctu es
El La ers
El Non -La ers
El Pullets
❑ Turkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes .0-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
ONE
❑Yes
❑No
❑ Yes
Ko
❑ NA
❑ NE
❑ Yes
FeKo
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: Date of Ins Talon: 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;�fNo
❑ 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 67No
❑ 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 ONo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes j `No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes j2flIo
❑ 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 �No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes ZfNo
❑ 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 ,E:rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes rj1 No
�r2'No
❑ 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 ;allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes j eNo
❑ NA
❑ NE
Required Records & Documents
rT
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
,E2-No
❑ Yes ❑'No
❑ NA
❑ NE
the appropriate box.
I
❑A1UP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. JaYes [—]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ErNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jfN0
NA ❑ NE
Weather Code
Sludge Survey
NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: _ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit.
Yes
❑ No
❑ NA ❑ NE
E
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
gRo
❑ 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
)Z"No
❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
fNo
❑ 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 facilito 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? ❑ Yes P No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 1—�-� NNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes YNo ❑ NA ❑ NE
❑ Yes 6No ❑ NA ❑ NE
❑ Yes
7'No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Comments (refer to question #1): Explain any YES answers and/or any additional recommendations or any other comments s::
Use drawings of facility to better explain situations (use additional pages as necessary).
1�d
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 01'6^- 7 36
Date: 7 y
4/2011

Facility"Nunilier, 3 {
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visil:WArrival Time: f%+ Q a Departure Time: Count-. � f € Region: W o
Far€n Name:H r 1 Y 1^'� .. Owner Entail:
Owner `'acne:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Fl a h _ ._ t) h_ _ Integrator:
Certified Operator: t I a h o h.a_ _ _ Operator Certification Number:
Back-up Operator:
Location of Harm:
Swine
Back-up Certification Number:
Latitude: ❑ ° ❑ 1 ❑ u Longitude: E10
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Lt 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges 8i 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
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ 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 a No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
S No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Write Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stricture i Stricture 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard tin): 20
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes NJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 6
❑ Yes 20 No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes JK 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 9 Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X) No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 29 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑App�liic�ation Outside of Area
12. Crop type(s) P G 1\, LP) , G- 0 Yefs e" G, W.
13. Soil type(s) A+ vl I I P Le on
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
wAI_ f10110C& o,ss �- 3�r�rti9 k �.o
ST�� S j��! °� - M��ti Q� L�ml? t1P��e Z;qc f C V'Oper 0 X �
d
Reviewer/inspector Name C O W ( un Phone:
Reviewer/Inspector Signature: X Date: r ?
Il/151U4 t.onanuea

Facility plumber: 3 1 Date of Iuspertion F
Rc uired Records &Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IS No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P9 No ❑ NA ❑ NE
the appropiate box. 0 WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 16 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ Annual Certification
O Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections [] Monthly and V Rain Inspections E]Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 09 No ❑ NA - ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
29 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 N No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?;
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZINo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
99 No
ElNA
❑ 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
RNo
❑ 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
29 No
❑ 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
FS No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments and/or
#Q le4Se te9Arflr�P1,,ce q;r vch
Z� Plegy r iax G C1)0y 0 � (u)i 6Y'A-f;L>h
TO r Keyt'n R5wlghd
9 10 - �To— 2156It
Izn81a4

vision of Water Quality
Facility Nut fiber 0 Divisimof Soil and Water Conservation
- O Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access!
Date of Visit: G 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:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Owner Email:
Phone:
Phone NO:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = " Longitude: = ° 0' 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ELaerNon-Layer -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struc e l 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
M. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date: D
12126104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
91 Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
dZS� ►`�6 bjk .sur�J 2a�- �Q 6�r }� Ga�
4k1 b �O
L p
Off" * Ve coro�s (�A
Page 3 of 3
12128104

Division of Water Quality
Facility Number 10 Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit plioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: 0 v Departure Time: County:
Farm Name: J& �Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator• I/M Z6
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [= o [�] ' 0 Longitude: = ° = N
Design Current Design . Current
6.
Saline t"anaeity Pnnnlatinn Wet Poultry Ca acity Po elation
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other - -- —
P P
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke 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
Cattle .Capacity`
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ 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?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
El NE
12128104 Continued

Facility Number: 3 —J/ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
`.Comments (refer to question ft Explain any YES answers and/or any recommendations or any other:comments
. . _ F �s taw
Use drawings of facility to better explain situations. (use additional pages as necessary): t 4;
Reviiewerllnspector Name Arey k ryw�Gh C/Li Phone: Q/GL 6l `,Fa'—
Reviewer/Inspector Signature: ZZ Date: 4 O
Pape 2 of 121AI04 Continued

Facility Number: 21 Date of Inspection
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El 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 ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
9Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
PYes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
/
�J
l� Co�G�S
uYl1'1 ! OI�eC S oace"
Page 3 of 3 12178104

Type of Visit 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visitl&fioutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: Departure Time: County:
Farm Name: 1 �t`�, tj T C.IL 6V r _— Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: &xk
Certified Operator:
Back-up Operator:
Phone:
Phone o:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region-`J.�.
Location of Farm: Latitude: 0 e = S =,, Longitude: = o =, =
Design Current
Design Current
Design Current
Swine y,
Capacity= population.
Wet Pouffry Capacity Population
Cattle ` C•apacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
t
iry Calf
eeder to Finish
iry Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish❑Beef
❑ Layers
Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
oil,Other
arkey Poults
❑ Other
ther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes )ETNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes ZfNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 1 — Date of Inspection
Waste Collection & Treatment
4. Is•storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ; No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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 eNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes .gNo ❑ 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 ZJ'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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 10No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence/of Wind Drift ❑ Application Outside of Area
12. Crop type(s)� ff v V Py s ( J
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
!TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
❑ Yes
•, "No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
y� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F
,;,Ko
❑ NA
❑ NE
Comments (refer�,to question #� � Ezpla�n any�,YES�answers and/ anyrecammendations or any ather comments.
Use drawmgs�©f�facrltty.to.,better�explamtsttuataons :(use adldtt,vnaltpagesaas necessary :
Reviewer/lnspector Name LKPhone:
Reviewer/Inspector Signature: Date:
12/28/ 4 Continued

facility Number: 3 Date of Inspection
Required Reaurds & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes J:;JiVo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes. check the appropriate box below. 0 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ;alVaste Analysis ❑ Sail Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes,,ETNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J2No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No �NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
ErNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes J2'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
Ef'NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes .ErNO
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes P-No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [,IKo
❑ 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
El Yes ,EYNo
❑ 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 /ffNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes J:2 Co
❑ NA
❑ NE
Additional Comments and/or Drawings:
(�1 V'\-&01A) r j01, P`kmil r`J
e AnA62,
ocd e- co C
1 Y` (��
0(-69IR3 %
12128104

of Visit OrCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
for Visit (yRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other E3 Denied Access
L Facility Number Date of Visit:
-1� ,JqPermitted [a eirtified 13 Conditionally Certified 13 Registered
P
Farm Name: -----------
Owner Name:
-Mailing Address:
Facility Contact:
Onsite Representative: .... ...
�WL— Z
Certified
Location of Farm:
Time:
Not Operational OBelow Threshold
Date Last Op Abo e Threshold:
IA�l
County:
'Phone No:
PoeNo:
Integrator
Operator Certification Number:
lswine 0 Poultry 0 Cattle 0 Horse Latitude 0 1949 Longitude 0 1
emSwiae p
Wean to Feeder
to Finish
Farrow
arrow to Wean
Farrow
to
arrow to Feeder
Farrow to Finish
iulation='
711- 4
77�
Totem Design," ad
'p,
ToW SSLWJ�":,
PighMes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon 0 Spray Field 0 Other
a. If discharge is observed, was the conveyance man-made?
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were them 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? E] Spillway
Structure1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Frecbdard (inches):
I&
[]Yes 1231RO
[I Yes El No
El Yes 0 No
[I Yes [I No
❑ Yes M-Ko
❑ Yes ffR0
0 Yes -O'No
Structure 6
12112M3 Continued
i

Facility Number: 7:V31 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,© No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes'0-Mo
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 LIM
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 12-No
9. Do any stactures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑-No
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceCunprovement? ❑ Yes �io
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ®'No
❑ Excessive PP,onndding ❑ PAN Hydraulic Overload ❑ Frozen Ground ❑l Copper and/or Zinc
12. Crop type /�/-�d�7�1%%r ' e'_ ) �LaLC .��vs��/i' /. S Cc.J/
13. Do the receiving crops differ with those dl=si'gnated in the Certified Animal Waste
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Plan (CAWIVIP)? ❑ Yes -®'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑:N' o
❑ Yes 'Ej No
16. Is there a lack of adequate waste application equipment? ❑ Yes _]-No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes �2M
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? [I Yes EJ'No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes EJONo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional ❑ Yes ;].No
Air Quality representative immediately.
........�.� .. �r�a .�¢ .:�.T •ass' "L.". _.3'.t"^;.ii"5 F ,_ _ z"�'-:C",€ _ _`r- _� �rs
Comments (r1im4w to question) z�mty YES ewers $adlor irr Anf(Other cammen
_
Use of facwj to?betber a�plain sboati{use' pages as tY).- ❑Feld Copy ❑Final Noo� ;
i-
K r - -.;b_•y,-
�........«.
416
y
Hv
Reviewer/Inspector Name 24
_ ..
Reviewer/Inspector Signature:"Z. Date: :�"
12112103 Continued
4

Facility Number: 3/3
Rice aired Records & Documents
Date of Inspection 010 Gr`
21.e Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes LkNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(it/ WUP, checklists, design, maps, etc.) ❑ Yes ONo
23. Does record keeping need improvement? If yes, check the appropriate box below. JXYes _12No
❑ 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 , ONo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes J;-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Jallo
28. Does facility require a follow-up visit by same agency? [:]Yes Ej o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? [:]Yes Ergo'
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ,0tio
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35_ Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit tg Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit %-Routine 0 Complaint Follow up O Emergency Notn9cation O Other ❑ Denied Access
Facility Number
Date of Visit: �Q V— Time: r�7
18 /
Not Onerational 0 Belo' Threshold
® Permitted [&Certified [3Conditionally Certified 0 Registered Date Last Operated orlbove Threshold:
Farm Name: _ ��' ram, County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No: A441, 6 Onsite Representative: 6 _� integrator: 64
/ Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0` 0 " Longitude ' 0 0
Design lCurivnt Design Current- Design Curren#
Swine: 7Ca achy, Poa€a�on
Poultry q _Ca scity nPa ulation.Gsttte �. .Ca acrri ="Powulat�on
❑ Wean to Feeder ❑ La er Da'
;.
r e
Feeder to Finish ° ❑Non-LaveNon-Dairy
❑ Farrow to Wean , w
Farrow to Feeder k' ❑ Other
❑ Farrow to Finish iY = Total Design. Capaciilt
❑ Gilts
❑ Boars Y _ Total SSLW
Number of o4ns ❑ Subsurface Drains Present La oon Area ❑ S ray Field Area
_ �
,Holding Ponds°I Solid Traps - ❑ No Liquid Waste Management System ._.
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
❑ Yes W0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? El 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 galimin?
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 Ea -No
1
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes D9 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches): ,
05103101 Continued

Facility Number: 2t—
Date of Inspection up =7ja
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 1�jNo
❑ Yes 5� No
❑ Yes ®.No
❑ Yes PLNo
❑ Yes PgNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes R No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload, ❑ Yes 5, No
12. Crop type r/�fu d>/ �.rrs�/ r( i O�csr-r� , C �r�r ���• ��y
a ' r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes CTNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes O 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
[P No
16,
is there a lack of adequate waste application equipment?
❑ Yes
PNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
PNo
I &
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP. checklists, design, maps, etc.)
El Yes
rn
► 3 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�9 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
P No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
P No
(ie/ discharge, freeboard problems, over application)
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
C& No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IN No
® No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ny anlloComttents(rferto questioersS r:any rmomeodations ur any ottter.com�eiits.
_
;Use drawings of facility to better explain sitnatloos. e(nse addtaonal pages as necessary) ❑ Field Conv ❑ Final Notes
_ --:.3�
C ,�` /
ry0TG /feed -Al V0I-A On -�ilC /'dl.�/'d� 1/1e, `edel _do /,,W 6e A Yea 74*.
�ntG 4f t/�k r
Ali£ 0 ke-4 !d`i0 7D A407'5�/ 6 a IAV- ` ��l �f �f 4 Ile j v i re,,fl
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Condnued

Facility lumber: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes RNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [�r-Vo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt ElYes [�LNo
roads, building structure, and/or public property) V
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes &o
A 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 EkNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [L NO
Additional Cornments and/ar Drawings:
05103101

(Type of Visit GYCompliance Inspection O Operation Review O Lagoon Evaluation {
Reason for Visit ,O'Routine O Complaint O Follow up O Emergency Notdication O Other ❑ Denied Access Il
Facility Number 313
Date of Visit: / ,3 a i Time: 12 a 5
Q Not Operational Q Below Threshold
Permitted U Certified 0 Conditionally Certified © Registered Date Last Operated orAboveThreshold: .........................
B\ « 'i .�V r:✓t
FarmName: ......... .......y�.........................r'l.... �`1................................:............................. County.........__.�._......................................
OwnerName:..... c� =��� al s.. B'.................................................................. Phone No:............................................................... ..... .....»» .
FacilityContact:............................................................................... Title:................................................................ Phone No:...................................................
Mailing Address:
Onsite Representative: .9..' k...�................................................................. Integrator:.. .Y..'................................ ....................
Certified Operator:.............................................................................. ......... Operator Certification Number:
...................................................................
Location of Farm:
❑ Swine ❑ Poultry []Cattle ❑ horse Latitude ' ; 64 Longitude • 6 64
Design_. Current-..
e�=� - � Canacitn Poaullabion
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
iVnmber_of Lagoons - I _.= . ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
-Holding Pon& ISolid Traps. ❑ No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed.. what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were,there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..............,.................... .................................... . ................ ...................................................................................
Freeboard (inches): 3 3
5ioo
❑ Yes 'WNo
❑ Yes ,21 No
❑ Yes lj No
h r oL
❑ Yes 9wo
❑ Yes wNo
❑ Yes 'PNo
❑ Yes JgNo
Structure G
Continued on back

Facility Number: 3 # — 3 13 Date of Inspection d O
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
i seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ,TNo
(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 ,E!TNo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes'oNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'ONo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [I Yes No
C
12. Crop type �er'wv�1 ev, ze l S+-at ! i 6e. o'n , Co-­t , W 1-,eot4 fa! j b got s
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,8 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility. require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Y;41 t�4> .0 dtrFc�encip . re Doted donog Ns:vWlt! - Yoo )<dl owiye 0e Cu�•tW
rorresponcience about this visit~
❑ Yes ❑ No
❑ Yes ONo
❑ Yes ZNo
❑ Yes 'RTNo
❑ Yes kfNo
❑ Yes J;TNo
❑ Yes JZN0
❑ Yes ,8 No
❑ Yes ONo
❑ YesoNo
❑ Yes J'No
❑ Yes j2rNo
t rqr• 'J?o­Ld sa S Ine mo%keS ppuIts in 6er'vt. vAq �;`Pla(di`F e✓P 1� - l,�n
S�,.dt•�� b wc#�c, ble ctz- Cs deTef ; soh • we d "s6vs-.5cot weki4 Ie
aGreS d ���i �.a.� : a,., 1r+eda �e Ac GP �d :,r,� -�-a Lila. ��'• T3o+-�L{ �
does ��s �vlir . eve ��t;.s dose gssaor,, as �vdss�bt� .
-Ae Ak4,1; 17 , crops) A Ad reco-nd s a re ,7e`t17 ke#.
Reviewedlnspector Name ohC'L,Jq t1 �1. S
Reviewer/Inspector Signature: Date: 101310 1 5/00

Facility Number: 3 J - 3 Date of Inspection J
.Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 0 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes] No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JO No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 'P'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
A"tional Comments. and/orDrawings:
it
5/00

)0 Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit )Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit j5Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 3 i' j Date of Visit: Printed on: 7/21/2000
rO Not O erational Q Below Thresbold
Permitted © Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .............
Farm Name: ......... . . ..I . .....T..��.r. ............................ County .. } �' 1.........................................................
................................... _ p_ .I . .
Owner Name: 'De t,vi.,,.....,............... ....4 IcS �d r1(.... ...... Phone No:
.. ................. ....
FacilityContact: ...............................................................................Title:................................................................ Phone No:...................................................
MailingAddress:...............11,.....................n......................................................................._.............................................................................................. ..........................
Onsite Representative:.,'{ ' 1` 1Jo Integrator: m e p �� "'Zr
.............r........................................................
Certified Operator:................................................... Operator Certification Number:.................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • C 16 Longitude • 1 «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish ZL} ,06 ❑ Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ) ❑ Subsurface Drains Present I0 Lagnan Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges S Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 14 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. li' discharge is observed, was the conveyance: man-made? ❑ Yes X No
h. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) El Yes %No
c. II'discharee is observed, what is the estimated flow in gal/min? j? G1
d. Does discharge bypass a lagoon system'' (If yes, notify DWQ) ❑ Yes 0No
2. Is there evidence of past discharge from any part of the operation? J9Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )Rf-No
Structure I Structure: 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...........................__.......................................... ............ .................. .....
Freehoard (inches): 26
5100 Continued on back

Facility Number: 3 Date of Inspection 1G 11 D Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
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 maintenancelimprovement?
❑ Yes
29 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
PjNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
[I Yes
A No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
] 1 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
,� No
��}}
12. Crop type r�eV'►nyD�C+T7A`1 ��'''` f �� ��rct;� COrrl�Ae0.ttSotit�egPnS
r)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
1�5No
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
VNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
V No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes A No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ZNo
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? 0Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes `gNo
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative'? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
0: Rio•yiolafigris:ot defde-n ies were noted•during this visit:• Vou will -receive de; further: :
corresporicience: a6otit this visit: ::::: ::
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1c�� (tea CJas�e� �
%r G0114e ►pled ;� dtea;r�ecaa, y . Do nol jet POV41U TO.Ce sM
al
-Z 9 or s,4e ref0. A'I ales;7.ta /;a
�- Cam.-��7e4e9 �,� 11 4o,nd rH.�d -10 ��,�ss an for.►,, b y /0/l3/vC�
Reviewer/Inspector Name�O
Reviewer/Inspector Signature: Date: I4/1I1Q10. 5100

Facility Number: 3 f -3 f Date of Inspection W11ttl O Printed on: 7/21 /2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge ;Wor 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 XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes fgNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ElYes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ;M No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? S Yes ❑ No
Additional Comments and/orDrawings:
r.
r
5100

Facility Number Dsite of Inspection `[
Time of Inspection —, 24 hr. (hh:mm)
Permitted © Certified [3 Conditionally Certified [3 Registered 113 Not Operational Date Last Operated:
Farm Name: County: ............ . ...�
.................................................................................................
Owner Name: .........
Facility Contact: ..............................................................................Title:
Flailing Address: .............
�
....
.......
..6..................................... OnsiEe Representative • .
.. �................... ... ...........................
Certified Operator: ................................
Location of Farm:
PhoneNo: ............................... .............................. ...............
............... Phone No:...............................................
................... ................................................................
Integrator:.................. ................................................
Operator Certification Number: ...............................
r..........................................................-................................................................... ...............................................................................................
.........i
Latitude �•�� C].� Longitude �• ��°�
Design urrenE _ „ Design 'Current Design Current
ne Point _ ,
Capacity Population' try. _ _' Ca icity Population Cattle Capacity Po ulation -
❑ Wean to Feeder ❑ Layer ❑ Dairy =
Feeder to Finish ❑ Non -Layer _ ❑ Non -Dairy
Ell.
❑ Farrow to Wean Y _
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish Total Design Capacity .
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons . ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
.Holding=Ponds / Solid -Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
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 bRrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O<No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ((,.//
Freeboard (inches): ....... 2...l�................. ..........................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes MNo
seepage, etc.)
3123199 Continued on back

Facillty Number:3 — =3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Vj�' Sy
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application).
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.. i. viol. . . .s. ..... ei�... mere nosed iiiwing this:v... Yai} will reeeiye Rio further
;correspondence: ab' f this :visit
❑ Yes XNo
❑ Yes kNo
[-]Yes t4 No
❑ Yes 19rNo
❑ Yes MNo
❑ Yes D4 No
[-]Yes XNo
❑ Yes [XNo
❑ Yes ❑ No
XYes ❑ No
❑ Yes li�No
❑ Yes O"No
❑ Yes kNo
'Yes ❑ No
0Yes ❑ No
Cl Yes WNo
❑ Yes 0 No
❑ Yes f rNo
❑ Yes No
❑ Yes No
❑ Yes gNo
Can>Ements„(refe. r toyquestion #) :Explain any YES answers and/or any rec©inmendations or any other comments.
iUse`drawiQ of facilitytwbetter ex .lain situations . use additional:` a es as necessa�
A.
eA
YJ 55 �
TO
Reviewer/Inspector Name ' _ _ _-[ "3O,
Reviewer/Inspector Signature:' \�� Date:
3/23/99

Faci ity Number:31 313 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 Yes [:]No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 9No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes q�No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes j 'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or �1
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [ kNo
3/23/99

" 0 Division of Soil and Water Conservation 0 Other Agency
Wivision of Water Quality
151 Routine 0 Complaint 0 Follow-up of DWQ ins ection 0 Follow-u of DSWC review 0 Other
Date of Inspection -1 t
Facility Number 3
Time of Inspection 24 hr. (hh:mm)
13 Registered 13Certified © Applied for Permit © Permitted 10 Not O erational Date Last Operated:
Farm Name: & ..... r-r, ....`_. ... ---.. County :.......... b'. ...........................................................
OwnerName: ........ _.......... + ...�OJ................... . Phone Not ........�`IM) .......................................................................................................................
Facility Contact: ............................................................................. Title:............... ....... Phone No:
MailingAddress:...... 8K......�:......lNC ......�iND�....�`............................................................��......................... ..�!�l?�?........
Onsite Representative: .................[1+-.........i�11.................................................. InteKrator:......... ............................................
..............
Certified Operator:.............................................................................. ..... Operator Certification Number;..----------.
Location of Farm:
i1.....jwn.....s.; �..a .....5.�z,,.�$ ....o�.S.r�I:ic.�..... ct .........4................I.� �._................... ...................................................................
..................................................................................... .--.. ---.. ... ... ...................... ....... .....
Latitude ==' =1 =11 Longitude ' =' 0"
Design ;Current
Design Cerrrent ... ©es�gn ; Current
Svnne Capaelty 'Population
Poultry
Capacity Population Cattle
:Capacity Population
❑ Wean to Feeder
❑ Layer
[IDairyFeeder
to Finish❑Non-Layer
J
❑Non -Dairy
❑ Farrow to Wean
z '
❑Farrow to Feeder
❑ Other
"'
❑ Farrow to Finish
�.
Total Design Capacity
�.
❑ Gilts
,
❑ Boars
Total L
s SS
:
F
A- Numbe of L goons' Holrhng P nds
❑Subsurface Drains Present
❑Lagoon Area
❑Spray Feld Area
Y�
❑ No LiqMP uid Waste Management System
_ E
General
1.
Are there any buffers that need maintenancelimprovement?
❑ Yes
® No
2.
Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gallmin?
!j
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
91 No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
to No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5_
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
`� No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

Facility Number: 3 � — Sl 3 1
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (LagoonsAolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
0 No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Freeboard (ft): ............. ....................................
Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
[AYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
UNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type 4�i�lk�(1 k .............IaIlti!Y L ........ a0.i..!.................... :? 4...... .......... 1� Lk -. ......................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ®No
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 revieWrnspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onl •
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 Pernut?
0, No.vitilations°oi deiiciencies.were,iloted-during this:visit.- You.,�rill recei've-no,f4ri er" ;
: . 0rre900deilce aliobt this:visit.:
❑ Yes JM No
❑ Yes M No
❑ Yes I)tNo
[9 Yes ❑ No
❑ Yes ® No
Yes ❑ No
❑ Yes ® No
[9 Vs ❑ No
'J1 Yes ❑ No
12. C641vtve e �4 .� trove e - 1ao��- (ixt". `
t-2SaVj I't,coo)% sjV
ni O
�g destj�,s
J in �i� tR1 cat, trzttnrt�s SI�tJ1P1 �Oe p s4e 4 co Vt Xq-?
Zrf'i s A, ��?t� Wa.S�t 0 eltlS Q �i4Y �"8 30 dkj 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:, 4r _ I J,- _ Date:

Routine O Complaint O Follow-up of DWQ inspection O Follow-uR of DSWC review O Other
Date of Inspection 1679
Facility Number
Time of Inspection 1 z-'{� 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex-.1.25 for 1 hr 15 min)) Spent on Review T. ZS
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: _ .. .:.._ ..
Farm Name: _......& ..........._........
.
Land Owner Name:..
Facility Conctact:...... MAr..,... ,, t.................... _... Title -
Mailing
_..----...... ,
Address: � 1�+1 _ y... r......._ ...... _....._,..... .....
Onsite Representative:.�Lif .... �.... ... ....._
Certified Operator: 1!�M1. f.�..s�............ ..... ..... ... ..
Location of Farm:
�....�_S. � � ..... r y!�...
County:.. 1�5�. .. ... ... _.... ..... �.
Phone No: ..._..... .....
Phone No:..��lU�`� 6 _....__.....
..... ..W&16tc... r_N.L...... .....................
Integrator: _...� �. ....... __......... _ .
Operator Certification Number:
Latitude �• �� ®u Longitude �1? • �` �t7 "
Type of Operation and Design Capacity
Design �C rrent Design CurrentDestgn Current
Swine _ . i'au! ,< Ir
uiation ?Y Ca act =Po ulation the Ca act Po "tilahoa
❑ Wean to Feeder by La er ❑ Dairy
Feeder to Finish o ❑ Non -La er ❑Non -Da'
Farrow to Wean`
Farrow to Feeder M 4Total i II Ca ae> oa y
� P fy
10 Farrow to Finish
❑ Other
-710
�u er of L oons
Subsurface Drains Present
Ma" /Holding Ponds
„ s ❑ L ❑ S Lagoon Area �` pray Field Area �.
general
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
IN Yes ❑ No
❑ Yes M No
❑ Yes 0 No
❑ Yes W No
❑ Yes [R No
VYes ❑ No
❑ Yes P No
GI Yes ❑ No
Continued on back

Facility Number: ... 31......
�...3i _
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? W Yes PDNo
8. Are there lagoons or storage ponds on site which need to be properly closed? [--]Yes ® No
Structures (Lagoons and/or Holding Pond
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Freeboard (ii): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes IM No
It. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? 9kYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste AP-Plicatioo
14.
Is there physical evidence of over application?
Yes
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
I
Crop type _.................... �..�......_ .... ....._....... ......
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
i
❑ Yes
gpjNo
I7.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
E9 No
18.
Does the receiving crop need improvement?
❑ Yes
IN No
19.
Is there a lack of available waste application equipment?
❑ Yes
6ONo
20.
Does facility require a follow-up visit by same agency?
0 Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
f �No
For
Cfrtified Facilities OpJ,v_
' 22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
N No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Z No
24.
Does record keeping need improvement?
❑ Yes
ANo
Continents (refer to queshoii_ #�} Explain any Y>✓S answers and/or any recommendahons:or any other comments
Use drawings.of facihty to bi tter.expla�n situationjuse:additional pagesls necessary) d
r �.'
i . $� 9.x-p�r� S� �� a•ce� ► ��rovl
3_
,attic
rtMo�.
(1. t.a Qan Sti\OIM be, Fv+k�e Ravi. g i!) hQ resedo�. �tc4�er JIrce 54�cu�t� let �C+novrc�.
Owr a-qV-MV4A f Out-W VuV%o�c -� 6_o0�ed a4eo..
'j. I.JirL�i c �or� 1 S ct+*: �4 d 6"Va6 - 6k i 5 ono{' d[Si t�ha�`ec� +Lj- S�` G•
Q
cc: OwLSlOn of water Vitality, Water Viiality Section, r'acllity fissessment Unit 4/3U197

t Site Requires Immediate Attention: X
Facility No. -31- 0
DIVISION OF ENVIRONMENTAL MANAGEl4ENT
ANR AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1996
Time: 1_Z : 3 Oa
`t - n 7l .gam_�� JQ MnVc fA e,ft 6 w ►T Farm Name/Owner: �av-C ,n o ,�l.c.,:.
Mailing Address: gc�5 � Sd Lj Al IA-ci ,✓�_ -
County: t 1 L :ti - - - -
Intearator: ' Phone:
On Site Representative: Phone: Z 59 - 7 Y 741�
Physical Address/Location: � 1 Sr 31 Ae�x. MAf � �L3 v 9 Se- (kZ7
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: q 000 _ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
_Circle Yes or No .
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot _ 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard:. Ft• Inches
Was any seepaga observed from the laaoon(s)? es)or No Was anv erosion observed? Zes r No
Is adequate land available for spray? &or No Is the cover crop adequate? Yes or No
Crop(s) being, utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling,s? iO or No
100 Feet from Wells? )Z�or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream?�or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 0(�5
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No . If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes okilgP
Additional Comments: 0RF_Z-ris,ti7 r.,S 106ck3 4aJd ~t-o
41 eejG 7 v 10 Q ten
MI.-
At'R fS 64) R
i.yn
Z.e-,LtaYC
wadi l Lt4 ocp q .
ey 1-6
-r64
meQ
a Z�. kG t.��, LS__►2r �
e�.� �.t ,�ii �P�[ uti.,� f) pP l�.: `rkz
Sal � �.�1 �—��_IV�S
_
a(:a.c.s _ d
,
- L /• `!'% • a rs.�v+-� w i li+v�
Z X! Z L
s c
Inspector am
cc: Facility Assessment Unit
ignature
I: se .attachments if Ne-lded.

1 Site Requires Immediate Attention: X
Facility No. 31 - 3l3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: (o - I .. 1996 -
T' 1 Z: 3me
Oa
-- -----r
Farm Name/Owner: k_DcQ'_Cn( 2-n. a r► e� wi�� re 1., : '�� .} l�l�,n 1C- fA Qwt C• fe�
Mailing Address: F,64 �" wM So j(f , 1.z(1/hf ,0-r-
County: 7 a 1 L ZeL -
Inte-orator: ' Phone:
On Site Representative: t oL-P cv 3 o N Phone: Z 59 - 7 Y 7 `%
Physical Address/Location: "� `= - { ors v 1 87
Type of Operation: Swine -Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number. ACE DELI Certification Number: ACNEW
Latitude: Lon'gitu'de: Elevation: Fee:
.,:,:Circle Yes or No -
Does the Animal Waste Lagoon have sitf'ficient freeboard of 1 Foot _ 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes -or No =. ' . Actual Freeboard:: FL Anches
Was any seepage observed from the laQtion(s)? Oee or No _Was anv erosion observed? es�or•No
Is adequate land available for spray? or No Is the cover, crop adequate? Yes or No
Crop(s) being utilized. e-�?
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? iO or No'
- 100 Feet from Wells? YOor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line S tream?(rRlor No
Is animal waste land applied or spray irrigated within 25 Fees of a USGS Map Blue Line? Yes o(:f§
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No . If Yes, Please Explain -
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cove: crop)? Yes okT5)
Additional Comments: e�AF-"-Vi;6-2 146rS 10 j 5 j -ro w [- ►".-. r�en�a
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t-�o15� �•l�, s..sf
Inspector arm
ianature
cc: Facility Assessment Unit Usd Attachments if Needed.

Site Requires Immediate Attention:
Facility No. -3 L313
DIVISION OF ENVIRONMENTAL MANAGE?viEyT
ANIM_ AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: - - - 1996
Time: 3 00 P
Farm Name/Owner: PJAJ 6Loo L 6ig I klf"A-)
Mailing Address: 1 Z (e _& A e l A ajn _2124 - .(ma c_ Z &Lw
County: ti7
Integrator- �� i t aJ� Phone: 6, S 2
On Site Representative: Al (V C 1-T,a 1 Icy . hone: _ 2 KS- -Z (o i Z
Physical Address/Locadon: 1 S3 6- q • 1 UA
Type of Operation: S wine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Fee;
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot T 25 year 24 hour storm eve -it
(approximately 1 Foot f 7 inches) Ge or No Actual Freeboard I Ft. � Inches
Was any seepage observed from the lagoons)?(5�1or No Was any erosion observedZ:2j�or No
.` Is adeauate land available for spray?(9 or No Is the cover crop adequate? Yes ordo
Crop(s) being utilized: _Wee�6 '1r�'ES �S � ry 6 _S
Does the facility meet SCS minimum setback criteria?, 200 Feet from DwellinQs�or No
100 Feet from Wells? Yes oKo
Is the animal waste stockpiled within 100 Feet bf USGS Blue Line Stre aml�Dor No
Is animal waste land applied or spray irrigated within 25 Fee: of a USGS Map Blue Line? Yes ordo)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o 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�
Additional Comments:. A 6� d c7y1 sly c�i�iv�-, . 2,.9
i nn� V 6-nP
I' O
oy-y t' r� � c2 � �� � Yl'lG , �J.t �1 1 rM �-k-
�P-AT)UAJ. Q��S nJ ��J sovK� ea6-r1U
... ..
Spector N e e
cc: Facility Assessrnent Unit USI- Atcccfiments if Needed.

JUL-14-1995 15:22 FROM DEN wATER QUALITY 9FCTiOH TO
ilIF,r F.02i02
Site Requires Immediate Attention: (�
Facility No. ?L^ 35
i 3s }
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS STM VISITATION RECORD
DATE: 1995
Time:
Fan Name/Owner. G `1Ir 1 11� O iL -
Mailing Address: ' A �_
Counry_
Integrator• Phone:
On Site Representative: ��a � - k Y, -4 _ _ Phone: j /a -,ZR.!; 2 Cn _` -7
Physical Addressil ovation:
Type of Operation: Swine Poultry Cattle
Design Capacity: 4 D O o Number of Animals on Site:
DEM Certification Number: ACE DENT Certification. Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes o�o Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: -_ _ - {
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste Iand applied or spry irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: `
In spec for Name
Signature
cc: Faciliry Assessment Unit Use Attachments if Needed.

OPERHTI.ONS BRANCH - WQ Fax:[phone]
Aug 1 '95 10:22 P.05/08
Site Regan Immediaie A#tentiori:.�.; -'
--a;iiiry, N under:.. .,.
_ SIj.M VISJAATIVN R.=CWWI
DATE:
.Owner.. Fum Name: 11— - - - ;
County: 1, ••� - _
Agent Visiting Site: S' Phone: 91 d'" 2 ?6 —Z t 2!
Operator: Phone: _ On Site Representative: .. .phone:
Physical Address:
•
Mailing Address: - i 2 6 4k1e n
Type of Operatioa: Swine -I/— Poultry -- � Cattle
Design Capaciry: Number of Arusaals on Sire:'
L adrude: o Longitude: o
Type of Inspection: Ground V Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour stoma event
(approxLmately 1 Foot+ 7 niches) (!E� or No Actual Freeboard: , _ Feet ._ Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes do Was there erosion of &,.e dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Cornments.
Gou.. /W n 6 tr
Fax to [phone]
ALM
G,
Signat�,: �. cf Aj.rit

OPRRRTID,IS BRR1,]CH - i)K! Fax:[phone] Rust i '95 10 99 P.05/t1
517 �1 iS T troN. R ORD
DALE: 'T- 1-33 1995
Owner, �,� •n = - �. Farm Name::.
County:
Agent Visidng Site: �v� rhore:
On Site Rcpreseatative:--
Physical Address:
M a i U i i g Address: f Z 6_ 4 76r tar, d ��
J
Type of Opera*ion: Swine �� Poultry Cattle _
Design Capacity: -- _ - - Number of Anisna.i.s on Site:
Lat:tude:° �.` . " Lo�zztude: °--
Type of kspection: Ground _ t./ Aerial
• Circle Yes or No
Does the Animal Waste Lagoon have sufficient ireebaard of 1 Foot + 25 year 24 hour sroryr evcm
(arl rr,;C ately 1 Fact * 7 incht!s) or No Actual Freeboard: -_ J-, eL �� la, os
For facilities with more than one lagoon. please address t► e otl,er lagoons' freeboard under the
comments sect:oti.
Was Pry seepa;e observed from the lapoon(s)? Yes do Was there erosion �f thie darn?., z'es of No
Is ndegcatf! fend avaiiabir_ for land application? yycs or No is Lhc cover crap adco_iatc? Yoe; G'r NL,
Additional Com-ments: a
�.