310339_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

EA
Type of Visit: Q Comp ' e nspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: - r / Arrival Time: 2nP Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative:`^ �'-
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: T T k_Q 9 S_
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
D , P.oul ,
Layers
Design
C*_a aci.
Current
P,o
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
41"e-eder to Finish
j 7
3 4
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Turke s
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Boars
tither
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 2-9�o❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 'No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: / - Date of Inspection: 5 14 3
Waste Cdllection & 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 E2rlZ ❑ 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 1 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q-1 _❑ 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
❑,lao ❑ 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
nNo ❑ 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
l2. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3 go ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El' -No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ Io _❑ NA
. ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
[] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. D record keeping need improvement? If yes, check the appropriate box below.
es
No
❑ NA
❑ NE
ante 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
❑-No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA 0 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes. To ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes EdNo ❑ NA ❑ NE
❑ Yes E] N,o
❑ Yes C2-1Vo
❑ Yes ['Flo'
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any°YES answers and/or any additional recommendations or any other cotnments'
Use drawings of facility to better explain situations (use additional pages as necessary).
2 G Q Lt �C�-��� 2 7,
/7-4'LYe' (0' .
01-<_� o (s
Reviewer/Inspector Name: �,�-� l [� (" p Phone: _VT (0? 9L 77py
Reviewer/lnspector Signature: �`'�Date: ­3 1,Z,
Page 3 of 3 21412015

7]
LType of Visit: a►Com ' nee Inspection V Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: ' S County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �`' `_ C_ C C-O'"
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 4 1 i_�o 9 9-
Certification Number:
Longitude:
o Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dai Cow
Current
Pop.
oFeeder
7Feed
Non -La er
Dairy Calf
to Finish
to Wean
36 2 7 0
Q . P,oultr,
Layers
Design
Ca aci
Current
P,o ,
Dai Heifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [3 iqo l__I NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
[2'1q"
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

F*iiii umber: jDate of Inspection: / b
Waste Collection & Treatment
4. Is heavy less
Yes
No
NA
storage capacity (structural plus storm storage plus rainfall) than adequate?
❑
Et
❑
❑ 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):Z
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
FZVo
❑ 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
[31�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[6
❑ 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
❑-115—
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P-Mo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E:rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): D C /-A- 1 It &41Z_C Hq
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 'Flo
❑ Yes Vo
❑ Yes [/" No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes P'No ❑ NA ❑ NE
❑ Yes �' o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [a'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [;�<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 0 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? 0 Yes ❑'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2lo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: /6
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ❑' oo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [/]" o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E '9A_ ❑ 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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [] N ❑ NA ❑ NE
❑ Yes Ef No ❑ NA ❑ NE
❑ Yes 7o ❑ NA ❑ NE
❑ Yes L!' T ❑ NA ❑ NE
[:]Yes [;]-No
❑ Yes [:jNo
❑ Yes [3-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any: other comments.
m.
Use drawings of facility to better explain situations (use additional pages as necessary).
[Clk j e r-V C
Reviewer/Inspector Name: —a.— --
Reviewer/Inspector Signature:
Page 3 of 3
Phone; �j`i (Q 77 4i 73w q
Date:
21412014

r
for Visit: O�Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f Arrival Time: i( Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: S-� C` c 6 rk� Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
17 5-oY�-
Swine
Wean to Finish
can to Feeder
Design Current
Capacity Pop.
Wet Poultry
I ILayer
I INon-Layer I
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Dairy Calf
Feeder to Finish
341L 35vp
Design
i
C►urgent
P,o ,
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes E! No ❑ NA ❑ NE
[:)Yes [ No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

i,
Facility Number: A jDate of Inspection:
�z r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ea<
❑ 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: Z
Spillway?:
Designed Freeboard (in): 1 i ,Z
Observed Freeboard (in): L(
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
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[7"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
EEJ 1 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ET5o
❑ NA
❑ NE
maintenance or improvement?
1 l . 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 0 Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑�<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo'
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3<o ❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L/
❑ 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 ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L'J N _ ❑ 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 21412015 Continued

Facility Number: jDate of Inspection: �2 !"
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [/ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3 No
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 0 0
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes 0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
[] NA [] NE
U NA ❑ NE
Yes 0No NA ❑ NE
❑ Yes No NA ❑ NE
Yes No NA NE
Yes No NA ❑ NE
0 Yes ONo NA NE
❑ Yes No NA NE
[:]Yes No NA NE
1\VYIV YY 6nlf 111.]1J 1.L1V1 1\Li11lL. V` 111V111.. ` � /
Reviewer/Inspector Signature: Date: 2 z
Page 3 of 3 21412014

Type of Visit: 0rCo6pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,�? Departure Time: County: Jr�Region:
Farm Name: C_ 9 _ ::;� . Owner Email: �T7
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop..
Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oult ,
Ca aeity
P,o
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes 'O"No ❑ NA ❑ NE
Discharge originated at:. ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes., No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes EZNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes J�TNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/20II Continued

Facility Number: - Date of Inspection:Zy
Waste Collection & Treatment
4 AIs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes E!fNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: i Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes )' No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes [�rNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes C2'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes JE!No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence rof Win ri ❑ Application Outside of Approved Area
I` \ . .A
12. Crop Typc(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 ,fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ;"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ONO
18. Is there a lack of properly operating waste application equipment? ❑ Yes ZNo
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes r No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ZfNo
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
❑ 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 Z] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes �eNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ WE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[] NA ❑ NE
Page 2 of 3 21412011 Continued

lFacility Number: -I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,TNo
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes J2 ' No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Jallo
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?
24. 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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by' the same agency?
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes L2-No ❑ NA ❑ NE
[:]Yes
R'No
❑ NA
❑ NE
❑ Yes
J:�No
D NA
❑ NE
❑ Yes EjNo ❑ NA ❑ NE
❑ Yes L'No
❑ Yes ZNo
❑ Yes Eno
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: .� /
Page 3 of 3 211412011

Type of Visit: _f,:3�'Compliance Inspection V Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up 0 Referral Q Emergency Q Other O Denied Access
Date of Visit: �rrival Time: Departure Time: County: Region:
Farm Name: _ S �-jl%� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
%-Y—
Certified Operator:
Phone:
Phone:
Integrator: rn Zj2
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Murrent Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Curren#
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean Design Current
Farrow to Feeder Dr. P.oultr. Ca aci P.o ,
Farrow to Finish . Laye
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
QEher
Other LiqLber
Turke s
Turkey Poults
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 ,Erl4o ❑ NA ❑ NE
❑ Yes
jErNo
❑ NA
❑ NE
❑ Yes
PNo
❑ 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
o
❑ NA
❑ NE
❑ Yes
Z
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
Page I of 3 214120II Continued

Facility Number: jDate of Inspection:
Waste Collectibn & 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 ❑:] ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: [ 19--�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �C f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ 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 PNo ❑ 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 iLJ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [?fNo
DNA
❑ 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 PNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
P
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes nNo
-'
❑ 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 J2 NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ,I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ❑ No ❑ NA DONE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [ ] No
❑ NA
WNE
18. Is there a lack of properly operating waste application equipment?
[:]Yes [:]No
❑ NA
NE
Renuired 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 J21 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:)Maps 0 Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �2rNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis . ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and i" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes oNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 9No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection:
24. Did"the fa'&lity fail to calibrate waste application equipment as required by the pe t? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,fNo ❑ 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 ZI No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes EfNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No
❑ NA ONE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑ No
❑ NA J'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 Z—No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Ofl�o ❑ NA 0 NE
Fse
mments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
drawings of facilitv to better explain situations (use additional ua2es as necessarv).
JAilSe ,SClr// ex - Uk71/1 a0/
s � y .
77s113 eUa l iG
3713
�2 car i n as
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
21
13
Phone: — T
Date:
1412011

Type of Visit Q'f,`ompliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit f yRoutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: . �G�j eparture Time: C� County:
Farm Name: 4��5 ,, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
11
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator
Operator Ce ification Number:
Back-up Certification Number:
Region: Z41 S/
Latitude: [= o = f Longitude: = o =, = "
:_ Design�gr Currents y,� Desigo Current Design Current
,.fVd•%•d :.A`
P
Sry�ne ��Capacety� Populataon,WetPoultryT Cattle @apacity Population
yCapacttyP.opulateon
El Wean to Finish j❑ Layer ❑ Dai Cow
❑ Wean to Feeder I JEJ Non -Layer ❑ Dai Calf
❑ Feeder to Finish, a ❑ Dairy Heifer
❑Farrow to Wean ��DrvP.oultry�'�. ; El D Cow
❑Farrow to Feeder ElNon-Dairy
❑ Layers
El Farrow to Finish El Beef Stocker
❑ Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
[] Boars ❑ Beef Brood Cowl
"'* ❑ Turkeys i
ft er &t ❑ i urkey Poults
,Number of St
❑ Other [gip? ❑ Other ructures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ YeszdNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
JZNo
❑ Yes
g�N
❑ NA
❑ NE
ElYesNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection 3 7
L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0No ❑ NA ❑ NE
Structur 1 Struure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
of
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Pl�o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes PNo ❑ 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? El Yes P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑'fqo ❑ 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 Q No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LQ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t 0 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
9-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
/0'No
<o
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any recommendations or any other commcnts
Use drawi�tgs of,facility to better explain situations. (useaadditivnal pages as necessary):
Reviewer/Inspector Name Phone: G-'G
Reviewer/Inspector Signature:
Page 2 of 3 n128/041' Continued

Facility Number: 3 Date of Inspection
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes dNNo ❑ NA ❑ NE
the appropriate box.
❑ W[]P El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O] No [--]'NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis .❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 110 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 7No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes C]'fio
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
El NE
and report the mortality rates that were higher than normal?
,8
"No
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes El
❑ 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
�
ElZ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes U<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency? -
❑ Yes P No
❑ NA
❑ NE
Additional Comments and/or Drawings: ` A
f
do l0 s li/v
L)
1117110
7/,`��6 3
T
Page 3 of 3 12128104

Type of Visit IUCompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit. C Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ! Arrival Time: Departure Time: County:
Farm Name: '�574' �.�' %� ! Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: !�
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Region: sue/
Latitude: =] o E�] ' E:j « Longitude: = o =' [� «
Swine
❑ Wean to Finish
❑ Wean to Feeder
Design Current
C►apacity Population Wet Poultry
Design
Capacity
Current
Population
Design C►urrent
Cattle Capacity Population
ID Layer
❑ Dairy Cow
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
Dry Poultry
❑ Layers
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
El Gilts
El Boars
Non-Lay
El Pullets
Other
❑ Other I ID
❑ Turkeys
❑ Turkev Poults
Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes V No ❑ NA ❑ NE
❑ Yes No
KNo
❑ NA
ElNE
ElYes
❑ NA
❑ NE
❑ NA
ElNE
❑ Yes No
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
I2/28/04
Continued

Facility Number: Date of Inspection 3 Zaa Ada
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 re I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
0
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes PNo ❑ NA ElNE
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 Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [� No ❑ NA ❑ NE
maintenance/improvement? l
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.) r
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
111 No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments {refer to'question #) Explain" YES answers andfor any i ecanimendat"0' or any other�com eats �� '
ij * �� o
;Use drawings of faeility.to.better explain-situations.(use additional pages as necessary)
e_ ...
ReviewerlInspector Name Phone: l�/' p0�r3S��t�
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: —33Date of Inspection 3 �3
Reauired 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 ❑ Maps ❑ Other
21.
Does record keeping need -improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
ElWaste Application ElWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ElWaste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[[[ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
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
V
❑ NA
ElNE
ElYes
VNo
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
INo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Additional CQ0kTents and/or Drawings _... u '
00L_
12128104

��F�ilit,� N.t<mber
I�YI
Type of Visit oCompliance
Reason for Visit VRou9ne
Date of Visit: Are
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Time: . ( Departure Time: County
Facility Contact: Title:
Onsite Representative.
Certified Operator:
Owner Email:
Phone:
Phone No-
Integrator•
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region:
Location of Farm: Latitude: [= u = 4 0 " Longitude: = ° = 6 0 «
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish I 1
10 Layer
❑ Daia Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non-DaiEy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other I
❑ Turkey Poults
❑ Other I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VNo
❑ NA
[INE
Discharge originated at: ElStructure ElApplication Field ElOther
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
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: '1j — Date of Inspection -159
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
L EMM
El NA ❑NE
Stnicture l Stnicture 2 Slmicture ? Structure 4 Structure 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 El NA El NE
through a waste management or closure plan? 11
❑ Yes EINo
❑ Yes E]Ao
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 Ap,
o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 �Ko ElNA ElNE
maintenance or improvement? r!
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X
No ElNA ❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /!
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
i ❑ Yes
,E/,N��o
1 �No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
4o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L:.1J1 .
❑ NA
❑ NE
:Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
4Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name l/L Phone: J -
Reviewer/Inspector Signature: Date: rZ
12/2810Conti ued
G

Facility Number: — Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes <a ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 'ZNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes P-no
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
P<es
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P<O
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
:rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Y 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
7No
❑ 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
O<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
UX
❑ NA
❑ NE
Additional Comments and/or Drawings:
a �t Iva 61
12'28/04

P

e
IType of Visit Q-Cbmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3 Departure Time: County: Region:
Farm Name: �
4—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: II Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator• �n
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = g Longitude: = ° = . = «
Design Current
Design
C*urrent Design
C►►urrent
Swine Capacity Population Wet Poultry
C*opacity
Population Cattle Capacity
Population
❑ Wean to Finish 10 Layer
I
I
❑ Dairy Cow
❑ Wean to Feeder ILI Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder
❑ Boars ❑ Pullets
❑Beef Brood Cowl I
[I Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
(dumber of Structures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
J�j No
❑ Yes
El NA
El NE
El Yes
�ONo
l No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection O G
waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: f/
❑ Yes ZNo
❑ Yes [f No
Structure 5
❑ NA ❑ NE
❑NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1-1L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2-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
2fNo
❑ 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
P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[ZrNo
❑ 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
[ZNo
❑ 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
[allo
❑ 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
,0 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EXNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
E No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
['No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[?"fqo
❑ 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):
w
Reviewer/Inspector Name ,
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3
12,,28/04
Continued

Facility Number: Date of Inspection l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ffNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
['No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ 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
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
6No
❑ 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
Z 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
,�(
L`J No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
16No
❑ 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
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
r vN l G� lS G�/tea _ C D�-s pC d
Page 3 of 3 12128104

Wision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
Q: Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit.,(EY-Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: 4�c� .15 �%yl Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Otti'er
❑ Other
Phone No:
Integrator•
Operator Certification umber:
Back-up Certification Number:
Latitude: = c =' = Longitude: 0 ° =
n Currenf ``Design' Current - Design Ci
ity 'Population Wet Poultry " Capacity` Population' Cattle - Capacity Pop
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?
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Da Cow
❑ Non -Da'
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
<:Number.of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
M
❑ Yes ,,21No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes /TfNo ❑ NA ❑ NE
12128104 Continued

FiEdity Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 10 o�
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 Ko ❑ NA ❑ NE
❑ Yes �ZNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes QTo ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
If any of questions 46 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 P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [3"No ❑ NA , ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [--IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ E idence 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 A 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 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
i
Comments (reefer 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): .
i
Reviewer/Inspector Name J Phone: �G
Reviewer/Inspector Signature: Date:
Page 2 of 3 I2 8/ 4 Continued

. _ •
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes --AZI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Yj No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
)/ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[]'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
DJNo
❑ 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
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
P 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
EJ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional. Comments and/or Drawings:
Ild
_�- 1
r fiw s /�
or�i-l��
Page 3 of 3 I2128104

l
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access /��%
Date of Visit: G Arrival Time: �0� Departure Time: � County: Region: rn-O
Farm Name: Sj�C `Sf/yl _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: �/ TC((� _ �_ i^�3 _ _ _ _ Integrator:
Certified Operator: Operator Certification ber:
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
Back -up Certification Number:
Latitude: = o =' = Longitude: = 0 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ 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 Current
Cattle Capacity Population
❑
Dairy Cow
❑
Daig Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Cowl
I
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 2rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
214o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: ) —33 Date of Inspection G
I
Wash Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: �-
Spillway?: pp /
Designed Freeboard (in): q �7� �— / /. Z-
Observed Freeboard (in): -?a
5. Are there any immediate threats to the integrity of any of the structures observed?
(iet 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 2No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes _Q No ❑ NA ❑ NE
❑ Yes 'CNo []NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes .'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes .0-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 PNo ❑ NA [__1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes A;] -No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes _21,10 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[JPAN ❑ PAN > 10% or ] O 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 UNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 2No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:]
Yes 13"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ETNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2'&o
❑ NA
❑ NE
gplaiuQ's tuations jifge-.add
Reviewer/Inspector Name I r ,. Phone:
Reviewer/Inspector Signature: Date: 4(p d- O
12128104 Continued

Facility Number• — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,21;o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1;� No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
1` No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J20m "Rlo
PKA
lE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
-J�?No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,E�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
-B No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E2'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
P-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
f 2-No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�1eases hay �a�n 57aESF oY. e47 ram,
• 3
71Z�_vyt-rj Gtct,5 c .
t K, ood
is �5
or' der 1y
12128104

Type of Visit O Co liance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility N er Date of Visit: I (o'125AW I Time:
10 Not Operational Q Below Threshold
Permitted Cerr``dfied GG© Coonditionally Certified © Registered Date Last Operated or Above Threshold: ..... __..
FarmName: .......... * '5 ... FA, P_M........................ ........................... - County:.........�{.................................................
Owner Name:.._ _w_...........__._......_� . ........... _.. .....� ..� _.. ... Phone No: ........ .
N- tw ing Address: ..................................................................................................... _................... ...... ........ .................... ... .............. ........ ..........................
Facility Contact: --•- ....... W . W.W .Title: ..__.......... --- —..... _. Phone No:
Onsite Representative:...... 51eue ... G aAoq -- - -- - - •.....� .. Integrator:.. , ! PN..�_......................................
Certified Operator:.._....... ....._._.......�............. ......__ .._.__ ......... Operator Certification Number:......_ ......
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° ��� Longitude 0` 64
: f Ign'i
Current _ Des�n Current _ : Desrgn
Cp rent
-Pool Cattle ":
Swine, try_ Ca7 _ =Po
Ca alahon 'Ca
_
Po
�_ act
: Po . .. ulafau act
alahon
-,
[71Wean to Feeder
` ❑ Layer . ❑Dairy
it
-
"Weeder
to Finish
�❑Non-Layer , �� ❑Non -Dairy
❑ Farrow to Wean,
= , =• _ = ::x , �,,
5
Other
Farrow to Feeder
z -
A
Farrow to Finish
_� Total Design Ca aCity i
F
3
❑ Gilts;
Y
[] Boars
.� ota1�3S �, i
T W
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...............}................... ....... .... ... ... ............................. I...........................
Freeboard (inches): 29 15_
12112103
❑ Yes j�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes To
❑ Yes Wo
❑ Yes 10
Structure G
Continued

Facility Number: 31 — 3 3 Date of Inspection (o O
ire
5. there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
E/No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
Yes
40
❑
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
WNO
8. Does any part of the waste management system other than waste structures require maintenancehimprovement?
❑ Yes
O No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
Q No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
NN
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
;Z0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overloaadd ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Ng
14. a) Does the facility lack adequate acreage for land application?
El Yes
0
b) Does the facility need a wettable acre determination?
❑ Yes
�
�N
c) This facility is pended for a wettable acre determination?
❑ Yes
f�No
15. Does the receiving crop need improvement?
❑ Yes
2<03
WNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes L;,No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes l�No
� O
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes
Air Quality representative immediately.
' &&Aovf' VNwTA LXT' �E CA"S,
a6e CoPle ANNUAL, CZ CT.
f�a,m 4- 'ZEco"s
Reviewer/Inspector Name
Reviewer/Inspector Signature:
zw 6.aab SNAPS ,
Field Copy ❑ Final Notes
Date:
12112103 Continued

Facility Number: _ 3 Date of Inspection
Reguired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WLT, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Vo
❑ 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;No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit? /
(ie/ discharge, freeboard problems, over application) ❑ Yes 7No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? ❑ Yes 0
WMP 29. Were any additional problems noted which cause noncompliance of the Certified A? ❑ Yes ;zo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 2'�(es ❑
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
V�Nq
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes L`J
34. Did the facility fail to calibrate waste application equipment? ❑ Yes 7�
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes CEO
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Date 01, Visit: Time:
Facility plumber
-.JNot O erational Below Threshold
Permitted [3 Certified © Conditionally Certified [3 Registered Date Last Operated or Above /Threshold:
Farm Name: / County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: / Title: Phone No: j
Onsite Representative: �J? �rQ/[ �/ Integrator: ..__ u ✓•�h V
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 " Longitude ' 0
m Ca acity -Po �Fghon._ .PouEtry ... ... C arty I'o olari -C Design Curr+euf
Swine W_�..._a the ,.._.: ._._C8 arltt "PO EAtiOn r-
❑ Wean to Feeder == ❑ Layer =_ ❑ Dairy
Feeder to Finish 7Z ❑Non -La Non -Layer ❑Non-Dai
❑ Farrow to Wean-
❑ Farrow to Feeder ❑Other
_..
❑ Farrow to finish Total Djjjgw Capaeity _
❑ Gilts s
❑ Boars Total SSLV1�
,Number.,olLagooes 2 Subsurface Drains Present ❑ La oon Area ❑ S ray Field Area
M - ps ❑ No Liquid Waste Management System
Holding Ponds 7 Sohd;Tra
-.. € -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ERNo
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 ves, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes [ RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes SNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3�G
05103101 Continued

'qL
Facility Number: f —
Date of inspection 6Z
5. Are there any imrediate 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 ERNo
❑ Yes [2TNo
❑ Yes RNo
❑ Yes KNo
❑ Yes Eallo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes CgNo
IL Is there evidence of over application? / ❑f�Excessive Ponndding ❑ PAN ❑ Hydraulic Overload ❑ Yes 6.No
12. Crop type /�/�f444 .U'V41/ � �6��_,--
I3. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes MNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 6�jNo
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
&allo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
1ANo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
RNo
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
'E�] No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
&No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5tNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes B�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes L§ 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 [8�No
M No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Comments: refer to uestion # En Iatn`iiny_YE5 arEswen and/or an}, recommendations or any,utlterrc mmentsr
(_ q ) p
_ _
'Use draw of fatatty to better explaursituatioas. (nse addt4onal pages:as necessary) ; -F❑Field Cotv�❑ Final Nntec
-_�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

J .i '
Facility Number: 31— Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes f-No
liquid level of lagoon or storage pond with no agitation?
27. Are there anv 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 M No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
05103101

of Visit Q Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
FFacility Number Date or Visit: V Time: E f� J g�
Not O erational O Below Threshold
® Permitted © Ce 'fled (a Coyditionally Certified © Registered Date Last Operaoxior Above Threshold:..---...
Farm Name : ........ ......... ................................................ ................. County: ,......... �.1' �.... ...
.. ... .
lrx
Owner Name:............. .. Y...... ... ..... .......j..... Phone No: .......................................................................................
! ...................
FacilityContact: ....------ .. r.... .. .....Title:......................................................... Phone No:....................................................
Mailing Address: .................
ddress:.................
Onsite Representative:...-/��..---• .-�..... ................................................. I ..... ntegrator .... ....-.....�.........
Certified Operator: ............................................................... Operator Certification Number:...............
Location of Farm:
ks—wne ❑ Poultry ❑ Cattle []Horse Latitude �• �• �` Longitude �• �� ���
Design Current Design Current Design Current
Swine-.Capacityp_ . Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean :
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Deslgn:Capacity
❑ Gilts =
❑ Boars Totai'SSLW
NvmberofLagoons ❑Subsurface Drains Present ❑L-goon Area ❑Spray Field Area
Holdin Ponds / Sohd Tra s ' ❑ No Liquid Waste Management System
q g Y ...::
Discharges - Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
01/01/01
❑ Yes to
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
'(
❑ Yes o
Continued

Facility,Numher:` Date of Inspection /
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes K No
Structure 1 Struve 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...... ..... . . ...... .....
Freeboard(inches): ��77 ....................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 9 GN
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �To
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? /❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes too
11. Is there evidence of over pplication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes
12. Crop type I� _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
V�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
1 Vo
b) Does the facility need a wettable acre determination?
❑ Yes
CE�0
c) This facility is pended for a wettable acre determination?
❑ Yes
(IR"No
15. Does the receiving crop need improvement?
❑ YesVo
16. Is there a lack of adequate waste application equipment?
❑ Yes
�00
ere a wa y to C I 'U n rn-5wn
Required Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
",<No
20,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
o
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
JNo
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yeso
23.
Did the facility fail to have a actively certified operator in charge?
ElYeso
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
25.
Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
❑ Yes
No
26.
Does facility require a follow-up visit by same agency?
❑ Yes
o
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
01/01/01
Continued

Facility Nttapber: — Date of Inspection
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Printed on: 1/4/2001
❑ Yes <No
❑ Yes k 0
❑ Yes *0
❑ Yes *0
❑ Yes �No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
❑ Field Copy ❑ Final Notes
0 9..e„C,,r � pie(
I""1� o
r-qa;�-A- -
r 4�y- -OLD
,- �,,�I e-cs'°�—
P I
wow
�� 0
Otn1U nnir e # trN So -4,"
Reviewer/Inspector Name
Reviewer/Inspector Signature:
AD .
Date:
01/0I/01

jjtDivisiork'of Water Quality
_ - Q.1Divisi6n o(f Soil andWater Conservatton: '
Q'Other.-Agency - =
E
f Visit Compliance Inspection 0 Operation Review Q Lagoon Evaluation
n for Visit Routine Q Complaint Q Fallow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: Time: !� Printed an: 7/21/2000
I -/ 10 Q� Not O eratio al Q Below Threshold
/,l� Yermitted ❑ Certified Conditionally Certified Q Registered Date Last Opera or Above Threshold•
' t
Farm Name: ... ...................................................... County: 4 t%/VL
Owner Name: „ ,•.,--,- Phone No:
........... ..Zk-C21
............................................................Facility Contact: ...:............ Title: Phone No:.. ................................................
MailingAddress: Integrator............................................................................................:..............��...................................... ........................ ...,,.// .......
...............:y................................................ ................................................................
Onsite Representative:.......
Certified Operator:
Location "of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �" Longitude �• 0` �«
Desi8° Current Design Curren
Des! Current
gm
-
Ca ci Po elation Poultry .. Capacity Po elation Cattle
- -.
::-Pot don
Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish �7 —� :.: ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑ Other
_ Farrow to Finish TOW Design Capacity --
.:
Gilts
soars Tota1SSLW 1
vNgtinberof[Lago4as Subsurface Drains Present 110 I-ag-on Ares
© Spray Field Area
HoUlffig Pon&1Solid Traps. ❑uid Waste Management System
r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ 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/rain?
����_
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes %No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes 0�0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 12INo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:..,`.� �/ /,�
...
Freeboard (inches):
5100
Continued on back

Facility Number: — �j Date of Inspection printed on: 7/21/2000
5. Are there any imme iate threats to the integrity of any of the structures obse ed1 (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 b(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 %zo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ElYes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenancehmprovement? ❑ Yes V No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes . o
12. Crop type ') I T . 14., (n r A/ FIC
13. Do the receiving crops differ with those rdesignated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes A2�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes "iNo
`
b) Does the facility need a wettable acre determination?
El o
c) This facility is pended for a wettable acre determination?
❑ Yes o
15. Does the receiving crop need improvement?
❑ Yes ErNo
16. Is there a lack of adequate waste application equipment?
❑ Yes Q'No
Required Records & Documents
& General Permit
17.
Fail to have Certificate of Coverage readily available?
❑ YesNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
4No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
ElYes
A40
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
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?
El Yes
o
-To •violations:or delfieiencie5 were noted• during'this:visit; • ."tl will receive do'Further. ;
- . - corresporic#eiki a'hatit: this :visit: : :
r to ijuestion #): Explain -any YES ahswers-andtor a ky >re'mmeudations or any other co
facility to better explain situations. (use additional pages as necessary)
Reviewer/Inspector Name y�
Reviewer/Inspector Signature: e::;�
`
Date: J!� _ 5MO

Facility Ni�rnber: —�7 Date of Inspection f 7 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Jr
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes MI -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 T 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 kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4NO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Xlo
5100

'OperationDivisron of Soil and=Water Conservat#on Review
13 Division of Soil and,Water Conservahou `-;compliance Inspection
Division of Water Quality - Compliance Inspection a
`nP.Other Agency Operation Review r
n
1IRRoutine Q Com laint Q Follow-up of DW ins ection O Follow-u of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 66 124 hr. (hh:mm)
&Permitted 13 Certified 13 Conditionally Certified © Registered 113.Not Operational Date Last Operated:
..........................
FarmName: ....... .................................................. ....._....----.-----.-. County:......... 1-•�°�1�-1............ ................
Owner Name:.... ....................... ........................
Facility Contact: ...........................................
Mailing Address:
Onsite Representative:
Certified Operator: ...................................................
Locatiun of Farm: % —
Phone No: ............................................
..... Title: ................................................................ Phone No:...........
.................................................................... .............. ........................... I ........ I..................... ..........................
Integrator: .......... M
-.......................... I................
....................................................... Operator Certification Number:............. ................
r..........................................................................................................................................................................................................................................................................�
Latitude �0 ` •� Long tu. .
-lumber of Lagoons ❑ Subsurface Drains Present IpTagoon Area IDSpray Feld Area
Hding olPonds / Solid Traps =� ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is ohserved, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. Il' discharge is observed, what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [ZNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes eNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ANo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes X No
Structure l Structure 2 Structure 3 Structure 4 Stnicturc 5 Structure 6
Identifier:2.0
Freeboard (inches): ........... .................. .......
................. ............................ :........................ .................. ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes D'No
seepage, etc.)
3/23/99 Continued on back

Facility Number: `3� —`j3q
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 maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste zk lication
10. Are there any buffers that need maintenance/improvement?
0
�No
❑ Yes
❑ Yes
�(No
❑ Yes
ZfNo
❑ Yes
{f No
(-]Yes
W No
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes [ZNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes O<No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONo
b) Does the facility need a wettable acre determination? ❑ Yes WNo
c) This facility is pended for a wettable acre determination? ' <Yes ❑ No
15.
Does the receiving crop need improvement?
❑Q Yes
IX No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Re uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
O(Na
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
XNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0;7f No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes E8 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes PrNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RNo
El: N-yi4a,tidr,is :o'r• deficiencies -were noted- during �his:visic • Yoi� ;will-Teceiye Rio: further
:. correspondence: ahauti this :visit. • .:: ::. .
3/23/99

Facility Number: 3� —3 Date of Inspection �l
Oder 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?
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
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
Y�No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
D<No
[Additional Comments ar or rawings - -
r1q
3/23/99

0 Division of Soil and Water Conservation []Other Agency
n
x Division of Water Quality
F x f f
119 Routine O Complaint O Follow-up cif DWO inspection. O Follow-up of USWC review O Other
Date of Inspection !a 1,
Facility Number �I
Time of Inspection $ : v 24 hr. (hh:mm)
© Registered tj Certified 0 Applied for Permit [j Permitted [3 Not Operational Date Last Operated: ......„
Farm Name: S� S ..R.KIn........ It..I....................................... County: ........ D.uo:ih�...........................................................
Owner Name: ....................... `'!(e.....................1 !'d! .. ............... Phone No:... jjgLG7
................. ............... 1}.. .................
FacilityContact:............................•--............................................... Title:................................................................ Phone No:...................................................
MailingAddress:.........{. ........�mtm..-sza, ......................................... ........ 4...... .�.Svppin�..t..S.................... I......... .. �3G.��...
Onsite RepresentatSve:......--...�L......... ..... ......... Integrator:.-,- {°,luY
l..........................................................
Certified Operator:.............................................................................................................. Operator Certification Number:.........................................
Location of Farm:
.'An ..... c'�....... $Jg..... 4?.....`........,G....... Sim..U(..7............................................................................. ..... A
................................ ........................ .................. .....
Latitude • 4 " Longitude ' ; "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes q No
2. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated -at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notifv DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes W No
❑ Yes
[P No
❑ Yes
Q No
❑ Yes
V. No
❑ Yes Wo
[O Yes ❑ No
❑ Yes 0 No
❑ Yes 0No
Continued on back

Facility Number: 3 i —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsMoldine Ponds, Flush Pits,.etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier: 1 Z
Freeboard(ft):........ .......3............................... :.Z..............................................
10. Is seepage observed from any of the structures?
❑ Yes 14 No
❑ Yes ;D No
Structure 4 Structure 5 Structure 0
I I- is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) r�
15. Crop type QY..fr! t f.r ............. ��l....__.� 7( �O................r ........... U�i7l.- ..........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes ® No
❑ Yes No
Yes ❑ No
❑ Yes [A No
❑ Yes (§ No
•..................................................
$,Yes
❑ No
❑ Yes
MNo
Yes
❑ No
❑ Yes
&3No
❑ Yes
P No
❑ Yes
`>a` No
(&Yes
❑ No
0 No.violations or defcieneie's werenotedduring this:visit..You.rvill receive no farther
. '. - coerespondence about this.visit.. .:.
❑ Yes No
Yes No
{� Yes ❑ No
Cof uuents:(refia-16 question #) ,Explain any VES answers and/or in* reeommn iiaattons"'ar any other'comments k
Use drawings of'factlttY to<better explain situations. (use additional pages as necessarv)
n
�..s. r
v- t aA w,, Wkil shbold F31- 1 { �
��. F�roSi0ln cat oh ;nvu,— w�1/1 Qf f aew. l�l 5` -00 be_i V&3 mac► e eed gut i C,
e txf t^ C� Yofl� �.vtA� YJaC� f` I�.((� h-t3UOT�. Bares
i
R oot� z S ©�(�
j� 6t,1�t eUea�e
rnCJ� s 5 jj�1 �1 _ L � 1 J
°t' YuS �tGLCI`G!n Si�4s/�U vJ�Yw-
r-A, {r�%aCGO.
Yt'GJ�yr
5 UWJ�� gg{LLin i^ W
�ecc i n bt��a souiU 1
�t ���e�� art s�traY �cc)vr�s. �abej s�vcu� rtc�s
z -1�, copn tkcv cw� sl�o�tl
w ti lv cprm c �
Mtnn� t4Jet^� �Z��br` o n� �Yb?1ew C z5��5 �C, 7/25/97
Reviewer/inspector Name t
Reviewer/Inspector Signature: Date: g

® Routine 0 Complaint 0 Follow-up of DWQ ins ection 0 Follow-up of DSWC review 0 Other
Date of Inspection 1018
Facility Number
Time of Inspection Eo::] 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status- ® Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
' ❑ Certified ❑ Permitted or Inspection includes travel and rocessin
❑ Not Operational Date Last Operated: .. _ ...... .. . _.......... ..._._ ... _........ r... . _.._ ..... ... ..._.
Farm Name:!...County:....._......
Land Owner Name:..__ .. _�.L_ . Phone No: _C.q_j..g
Facility Conctact:... .._.... _....... ._..... ....._ . Title: Phone No:
Mailing Address:..... . �.. ..��r44:. __ .tl !SL.t:: i1S.... ..............I �,.x4 .... Q.11..A&...
r_ j► 3.�.
Onsite Representative:.t-o,.,. ......W ._... _..... Integrator: _, u.ac .:... ............. ...._..... _....__.
Certified Operator: . Operator Certification Number: _-J. U J. � ...._
Location of Farm:
15.n G a_ S. t< 5. ... .....5... TE.A., l2 :.2 5._.�
�. s�rS.� _�c...i . ?......w.t s....�S. 1. .............................•_.........----------------............ ..........__....... ......... ...
......._ ...... �y
Latitude • ryL ° G(if a Longitude • ©&
Type of Operation and Design Capacity
.� �Desigri Currents }� DestgtiCurrent FDesign�Current
Swtne� , Poultry r., ...Ca ' vPoi Mahon_: Cattle x. Ca aci a.Po 'ttlatton `
.. . Ca act : P.n' uliition �Y .u_ ._
❑ Wean to Feeder ❑ La : ❑ Dairy
CK—Feeder to Finish Non -Layer ❑ Non-Dairyj
Farrow to Wean
171 Farrow to Feeder Total Design�Capacity N�
Farrow to Finish T�
h o a15 W� 3U 'l�
m
Ms­
Y3 Number of Lagoons f Nnldmg�Ponds Subsurface Drams Present
g
�E
r
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/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenancelimprovement?
❑ Yes B No
❑ Yes ER No
❑ Yes Ej No
❑ Yes B No
❑ Yes
IN No
❑ Yes
JR No
❑ Yes
RR No
❑ Yes
allo
Continued
on back

Facility Number:......-
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ®,No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes RNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes MNo
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ®,No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes & No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
® Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
I& No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
0 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15_
Crop type .................. ... .......... .-.-.,.... �....
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?
0 Yes
❑ No
18.
Does the receiving crop need improvement?
❑ Yes
HNo
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
,& No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
For
Certified Fagilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
24.
Does record keeping need improvement?
®.Yes
❑ No
Comments `refer to''' estion v
( qu #} Explain any YES: answers and/or.any recomniendations'or any other comment`drawings of facility to better explain situations: (use additional pages as necessary)
a
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Reviewer/Inspector Name
Reviewer/Inspector Signature: - Date:
well_
E
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. 1-
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: O , 1995
Time: d p
Farm Na
Mailing.
County:
Integratc
On Slte kCjJ1CJC11LdUVC: KJ� AL7 606 f S-i 11tJ11C: CY V
Physical Address/Location:
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:' Longitude:" Elevation: Feet
Circle 'e�or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Ye r No Actual Freeboard: L Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or@)Was any erosion observed? Yes or
Is adequate land available for spray? e 9 No Is the cover crop adequate? &r No �J
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Ye or 00
100 Feet from Wells? QLejor No
is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or ro
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(R)
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)? QesIor No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.