310364_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Compliance Inspection 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: Zola County: t Region: W1 Po
Farm Name: —' s Owner Email:
Owner Name: �uiit °jG-^{� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 0Y-1V'�� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 9 n () U 1 2
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Nan -La er
Design Current
D P,oui_ . Ca aci P,o
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
DairyCalf
Feeder to Finish
Farrow to Wean
,
DairyHeifer
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
kesOthrurke Poults
Beef Brood Cow
11111 gOther
Other
Discharges and Stream 1mDactS
1. Is any discharge observed from any part of the operation?
[]Yes
[)<No
[:INA
❑ 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 DWR)
❑ Yes
❑ No
MNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[21 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
K No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

F,ucili .'Number: jDate of Inspection:
t
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
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0 No
1)p NA
ONE
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:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
IgNo
❑ NA
❑ NE
❑ Yes
[4No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
��o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rE] No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No ❑ NA
❑ NE
iComments (refer to question #) Explain any. YES answers and/or any additional recommendations or any other comments ,�
Use'dra of facility -to -_better explain.sitieationso-.(use;addition'al pages,,astnecessary)�. .
ZI,
wMA 06rS_�^-.e. fi,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
,I��r V�
Phone:
Date: 3 A7
21412015

Type of Visit.. 0 Co Hance 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: /Z County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
/ i
Onsite Representative: 1,)N9TA 0 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: oo
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
. Pop.
Wet Poultry
Capacity
Pop.
C•atile
Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
I
INon-Layer
I
alf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P�oult ,
Ca aci_ty
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
L10ther
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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? eyes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LkAjl
❑No ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (s
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ 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 ZNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No 0 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 [Z/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesONo
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes dl�❑
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesVNo
❑ 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 YNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

Faci;i Number: - Date of Inspection: Z p
�24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes �o ❑ NA ❑ NE
25. Is the -facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �WNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes FZ7 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesVNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes EZ
Y'No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
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 UNo
❑ Yes dNo
❑ Yes No
❑ Yes o
ElYes rNo
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
IComnients (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional eases as necessarv).
i�6fi 10/10 /1� 64h-fffle k)
ReviewerlInspector Name:y_J %d M W(
ReviewerlInspector Signature: v Date:
Page 3 of 3
15

(Type of Visit: 0 ZRoutine
pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance `/
isit:
Reason for V0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ! Arrival Time: Departure Time: County: Duen/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:j9T�}�j]�
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: q� o
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop. Wet Poultry
`' Layer
Design C*urrent
Capacity Pop.
Cattle
Dairy Cow
Dairy Calf
Design C•nrrent
Eapacity Pop.
Wean to Feeder
Non -La er
7
f
D , P,©nl
ILayers
I
Feeder to Finish
Farrow to Wean
Farrow to Feeder]
Farrow to Finish
Design Curren#
Ca aci P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Pullets
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?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[—]Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes rN
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Fadlity Number: - Date of Inspection: 6
k;Yaste Collection & Treatment
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: LA&6- Sd�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a`
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �NoD ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 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 1No ❑ 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 PNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [;I-f4o ❑ 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 ZNo ❑ 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 dPNO ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E(No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [2/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dpo ❑NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes yNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection: l•
r—a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
k.
21. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes VNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes FNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes [elNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes LIJ 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 C�/No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E2, 4o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes � �j No
TT
❑ NA
❑ NE
,.
omments re er to gnestion' xp am anyp answers an or any a tonal recommeudatiotis or any other comments, <_
Use drawings offacility td'bettereaplain situations,.(use additional.pages'asynecessary).;..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: 0 7Routine
pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: i 10 - I Departure Time: ® County: At1 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: �p iUr-I
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: 9 9 00 1 f.-
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
La er
Design C►urgent
Capacity Pop.
Cattle
DairyCow
Design C+urgent
Capacity Pop.
Wean to Feeder
IN ---Layer
Dairy Calf
Feeder to Finish
Dr. P,oul
Layers
Design Current
C_a am n
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
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 Q /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: 10
Waste Collection & Treatment
� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes &<O ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ado ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I7 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[:]Yes f ❑ NA ❑ NE
❑ Yes [' ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes La No ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes is ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [allo ❑ 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 u 1V % ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [io ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes ❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EA, ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes FNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
o ❑ 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
Ej No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C No ❑ NA
❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional paves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
V U Phone i(1
Date: (�
4 ra

(Type of Visit: ® Co fiance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: y Departure Time:® County: -� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �� /� Title:
Onsite Representative: y� 60 0-04A k. 7 V 1,S LiE,(t­
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current11111111111
Swine Capacity Pop.
RLayer
Wean t:Feeder
REFORM!
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean ta.A.
Non -La er
Dr. P,outt .
Layers
Non -Layers
Design
Ga aci
C►urrent
P,o
Da' Calf
Dai Heifer
D Cow
Non-DairyFarrow
Beef Stocker
Beef Feeder
Feeder
a
Farrow
Farrow
Gilts
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 0 No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes yXNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page l of 3 21412011 Continued

36
(Type of Visit: QJ CCopliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
` Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: IL i Arrival Time: Departure Time: County: DO TR/ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: S6,4jrT)AAN lN,:1-_Lkk1 - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 4rl 00 j 2-
Certification Number:
Longitude:
Swine
UGa0ac!itj1Pop.
Wet P altry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Finish
La er
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
2�{Lk g
26aa
l
7tullets
Design
Ca aci
Current
P.o
Da' Heifer
Cow
Non -Dairy
Beef Stocker
o Wean
to Feeder
to Finish
ElGilts
NJ
ers
Beef Feeder
Beef Brood Cow
Turke Pu Jlts
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
gN'
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: 31 - S-H I Date of Ins ection: U L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes &No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes [�fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regionai Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ,
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
[� o ❑ NA ❑ NE
❑ NA ❑ NE
ICJ "o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments'
Use, drawings of facility -to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: 16,H N A Q0 �_' u-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C D 7U �-73
Date: 11 t ?L
21412011

Type of Visit: 0 C pliance Inspection Q Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: 11 1 Arrival Time: J J Departure Time:. County: _DL14W Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: L��r�J'� f J,�►fQ. Integrator:
Certified Operator: Certification Number: 9 160/2-
Back-up Operator:
Location of Farm:
Latitude:
Wean to Finish
Laye
Wean to Feeder
Non -
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
�
D . .
Laye
Gilts
Non -
Boars
Pulle
Poults
Other
Certification Number:
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?
Longitude:
Cow
Calf
Heifer
Cow
Stocker
Feeder
Brood Cow
❑ Yes [] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ YesV'No
❑ NA ❑ NE
❑ Yes ❑ NA 0 NE
Page I of 3 21412011 Continued

Faolity,Nt mb er 31
ivision of Water Quality
rvtsion of Soil addVatet" Conseryatton
Type of Visit (;Routine
pliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit L; Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 16 Arrival Time: Departure Time: County: "L--W Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
1-0
J /
Onsite Representative: �+1J �l/ h��—Lt-�- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 0 A = i, Longitude: = 0 0 6 = «
Design
Swore Capacity P
' ❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish �{
❑ Farrow to Wean
_ ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
rent` «Destgn Current
V4
�s
lotion ry
'et Paalt ;Capacity„Populatronz Cattle
----- 11,1 ❑ Laver ❑ Dairy Cow
LJ Non -La +� er U Dai Calf
r El Daia Heifer
''llry Poultry
El Dry Cow
ElLayers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
I
I d
![tier_..
] Other
k
�-
on- arry
❑ Beef Stocker
❑ Beef Feeder
5 ElBeef Brood Cow
r Number:of.Structi
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field [IOther
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 LJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
M/N
ElNA
❑ NE
[IYes
Ltid'No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — 3 Date of Inspection
Waste Collection & Treatment
�
4. "Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: to
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
at, notify DWQ
environmenta711,
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
7wo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
[�/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
����
L"No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
0. Soil type(s)
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O'NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
l NNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
u
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
i (referto:questionF#):: ,Explaip:anywYES. answers and/or any.recmu
ngs of facility to betterrexplain situations. (use additional pages as.6
AL
Reviewer/inspector Name Phone:(?1o) 79 %3
Reviewer/Inspector Signature: Date: !6
Page 2 of 3
11
Continued

Facility, Number: Date of Inspection L U
Re-gtiired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes 3/No ❑ NA ❑ NE
❑ Yes R<O ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
eNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EI'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[��], No
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
NoN
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
L� No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
ETNo
❑ 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
ElE1 Yes
�,
o
❑ 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
[],in
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
U>K
❑ NA
❑ NE
e
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

1
Type of Visit ,Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit CJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: p Departure Time: County: 04 0 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J a N AiT RA )J M ,—sA _Lft_
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 Longitude: = ° 0 = u
Design Current
Design Current
Design
Current
Swine Capacity Population
Vet Poultry Capacity Population
Cattle EJULC.
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
❑ Dairy Heifer
Feeder to Finish
2,94
1 b-
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ ers
El Beef Stocker
Gilts
Non -Layers
❑on -La ers
❑ Beef Feeder
PI]EEDBoars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Other
10 urkey Poults
IFI Other I
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes C3 N ElNA ElNE
El Yes 4 No ❑NA El NE
Page 1 of 3 12128104 Continued

Facility Number:' Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA (V-0 0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): v
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tlsreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes1jNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Wo ❑ 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 L" I Igo ❑ 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? WNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ElNA
❑ NE
t5. Does the receiving crop and/or land application site need improvement?
ElYes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
VNo ❑ NA
❑ NE
N
17. Does the facility lack adequate acreage for land application?
❑ Yes
[I NA
[I NE
18. is there a lack of properly operating waste application equipment?
El Yes�No
❑ NA
❑ NE
77
U.ME rkbpa?
Reviewer/inspector Name CJG 1yr✓ Rt►� ��' Phone:L`y`t���—��
Reviewer/Inspector Signature: Date: ice' lti a
cz
Now 2 of 7 V 12128104 Continued

I Facility Number: 31 361-1I Date of Inspection tr o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have al components of the CAWMP readily available? If yes, check P yes ❑ No ElNA ElNE
the appropriate box.[ff`WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 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 InspectionFN.Oo
Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes D
IN
El NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes E R No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,.,d
L'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI 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
EJ 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
E Nc
❑ 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
[INA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
7No
❑ NA
❑ NE
12128104

31 H 3U
lType of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: d $ Arrival Time: �--l� Departure Time: County: D
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ud�+-��— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = = =4 Longitude: [� o [� ` [� `4
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
Design Current
Capacity Population
❑ Wean to Finish
ID Layer
❑ Dairy Cow
❑ Wean to Feeder
ID Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder El Layers
❑ Farrow to FinishEl
❑ Gilts ❑Non -La Non -Layers
❑ Boars El Pullets
❑ Turkeys
Other urkey Poults
❑ Other ID Other I
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
Beef Stocker
El Beef Feeder
❑ Beef Brood Co
of Structures:
INumber
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[]Yes E3No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ❑ NA [INE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection t a
.X
W6ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: % A n�
Spillway?:
Designed Freeboard (in): a6. 4
Observed Freeboard (in): _o g
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 ElE Yes
,��
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
ElNA
ElNE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Zbo ❑ NA
❑ NE
l6.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ N-A ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�rNo ❑ NA
❑ NE
�* ,� '" -
Comments {refer to question;#) Explain any Y<1�.5 answers and/or any recommendations or any other comments.
"e
Use drawings of facility to better explamysituations.,(use�;additevnal pagesras necessary): "
Reviewer/Inspector Name t7o ELL Phone:
Reviewer/Inspector Signature: Date: og
Pape 2 of 3 I2128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes n No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JO/No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes BJ 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? ElYes O N [INA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L :N ❑ NA [I NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes U<p ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 'Co ❑ NA ❑ NE'
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0140
❑ 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
Io
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
LI No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2rZNo
❑ NA
❑ NE
Additioiial.Comnients andlor_-Drawings:
r..
Page 3 of 3 12128104

sion of Water Quality
Facility Number 21111)�,"V'iIsion of Soil and Water Conservation ;
-- O Other Agency
Type of Visit (1Gompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 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:
Owner Name:
Mailing Address:
Physical Address:
0
Facility Contact: Title:
Onsite Representative: &Le 4
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = 6 0 Longitude: 0 ° = 4 [= "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
T.❑ La er
I❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current:,
Cattle Capacity Population, "
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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)?
Number of Structures: f .
�i
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,,La1Vo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
, -No
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/28/04 Continued

Facility dumber:>1 I_
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 9,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?
0 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 ErNo
❑ 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 PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes PNo ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA El
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 ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J�allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[2-No
❑ NA
❑ NE
17, Does the facility tack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑,No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
F6(lrm t S t ''V 5W
Reviewer/Inspector NameLuh ,�� Phone:
oe
Reviewer/Inspector Signature: Date: G'
12128104 Continued

Facility Number: 31.— Date of Inspection TA7 A -7
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 Wo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps [I 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 ❑ Crap 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 PNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9.No
[:1 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
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;a No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C-No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
J�kNo
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
El NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
g] No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Z`No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�blb7 A 7
�06
g'zz a 907
12128104

Type of Visit _'G°ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
i Reason for Visit 0 Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: ,� Departure Time: County: Regiort//:'�-�
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 11 Title: Phone No:
Onsite Representative: 2 L__ P_ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= c [= I = Longitude: = ° = 6 ❑
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity. Population
Cattle
C*apacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder I I❑Non-La
er
❑Dai Calf
Feeder to Finish ljq(14Y
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 Co
❑ Turke s
Other
❑ Other
❑ Tur ey Poults
❑ Other
Number of Structures:
i 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 pNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
.6No
❑ NA
❑ NE
12128104 Continued

Type of Visit R Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J6 Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �I
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: .T(O I Departure Time: County: Region: [�L[
k � / �
S f-�ii. l�y�L-. Owner Email:
Facility Contact: --� Tithe:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator
Operator Certification Number.
Back-up Certification Number:
Location of Farm: Latitude: [= e = ° = d Longitude: = O = ° = u
Design Current
]ign Currentigne
Capacity Population
Wet Poulapaci
7_'
P,.o ulation Cattle Caac Po uladon
p. =� �' .per...
❑ Wean to Finish
❑ La er
ti..�.t?' s.
❑ DairyCow .y
�.:p
❑ Wean to Feeder
❑Non -La er-J
J❑
Dairy Calf
Feeder to Finish
M . °
A
❑ Dairy Heifei
❑ Farrow to Wean
Dry Poultry
°'
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
ElNon-Layers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
_
❑ TurkeyPouets
Number of Structures:
❑ Other
❑Other
Dischartses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�Fe'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
Z No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L3 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

"Fact 'ty Number: ✓d ell Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ;Kes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Iallo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes. check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PNo
❑ 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 0 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA J:I-NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J;�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
DNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
_2�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[:)Yes
J:�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
;:�'No
❑ NA
❑ NE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
JD�Vo
❑ NA
❑ NE
Aditroital Cuinments and/or Drarvin s a
If)
Ike-
-2w. Xell
,;Ye"-1 /G'!�
12128104

(Type of Visit f2rCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 0"Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
)Vermitted,0 Cerdfed 0 Conditionally Certified 0 Registered
Farm Name: .l,J.Y�.�.r�.... 1�...�Y�,"m .............................................
i lime:
t
Not Operational O Below Threshold
Date Last Operated or Above Threshold: .........................
County: ........ ................. ........ ..............
OwnerName: ........................................................................................................................... Phone No:
MailingAddress: ................. . ......... . ............................ ... .. ........ ........... ........... .......... ... ... ................................................... _.......-. -
Facilitv Contact: .............................................................................. Title:............................... Phone No:
Onsite Representative:.. 1 ...WX. 2j. .... Integrator: ({,�"�
Certified Operator: ......................................................_...._................................................... Operator Certifcatio/n umber.....................--••-•----•-••....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 66 Longitude ' ° 44
Desrgu :Curt Design Carre9nt Desrgn Current
s
Swine aci r:`e aCPara Pi► hon,,-.,-WCa oMatron P
6
Wean to Feeder = ❑SLayer ❑Dairy
eeder to Finish y?yels � ❑ Non -Layer I 1 ❑ Non -Dairy
10
Farrow to Wean77
M.
Farrow to Feeder Other
Farrow to Finish - TOtal U esj Ca styAF
Gilts - P ..--:
❑ Boars �_ Tata1;SSLW
ti
Fc yNuniber of Lagoons s W
e.
Discbames & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 12-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes j 'Ro
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes "ONO
Strut e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -- - .......... .... _ ................_..- ............ ....... - -...
Freeboard (inches):
12112103 Continued

Facility Number- -��
Date of Inspection p
4
Reuuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
\'PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes po Vo
❑ Yes �No
❑ Yes 214o
❑ Yes eNo
❑ Yes 20&o
❑ Yes 'PONo
❑ Yes 00No
❑ Yes )EIrNo
❑ Yes 'Q�110
❑ Yes OWo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit OD -Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit is Routine O Complaint O Follow up 0 Emergency Notification 0 Other - ❑ Denied Access
Facility Number Date of Visit: Time:rO rt
Not Operational 0 Below Threshold
® Permitted M Certified O Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: County:
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Z 6 ,41---
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
` 0� 0 0Longitude
❑ Swine ❑Poultry ❑Cattle ❑Horse Latitude "
Design
Swine Ca ace
❑ Wean to Feeder
Current Design
P.o ulation P,©ultry Ca acity
❑ La er
❑ Non -Layer
❑Other
Current Design Current
P,o ulanon Cattle C•a acity Po ulation
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagaons
Holding Ponds / Solid Traps
❑ Subsurface Drains Present ❑ La o0o Area
Q ❑ No Li uid Waste Mana ement System
❑ Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Xo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes allo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — 3 Date of Inspection �1 l
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes K.No
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan? ❑ Yes &No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes &No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes N No
Waste Aonlication
l0. Are there any buffers that need maintenance/improvement? ❑ Yes &No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes CSNo
U. Crop type A_'Vf'4( L4 LlriEs�J if.F///lY�i�It !/®tvy_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes K No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
B.
Does the receiving crop need improvement?
❑ Yes
E .No
16.
is there a lack of adequate waste application equipment?
❑ Yes
$ZNo
Required Records & DoclMments
l7.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
&No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
IQ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
PS No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
E[No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
K[No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
6Z1Vo
(ie/ discharge, freeboard problems, over application)
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
9[No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
I of
142 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
a3ivsiu1 Ve l 395"- 5f A9 4 905— Continued

Facility Number. Date of Inspection /M
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes eVNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 19 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes QNo
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 KI 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 R1 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes bQNo
05103101

F_ Facility Number Date of Visit: ,� J ,3
O'ermitted [3 Certified 0 Con
]ditionallfy Certified ❑ Registered
Farm Name sl/ Q''1 l't.�.lS 1 .. „ "'..m
. .......................... ...........
Owner Name:...... `x ..w........'.e.�.�.. ......
Facility Contact:
Mailing Address:
Title:
Time: ��Printed on: 7/21/2000
0 Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County: uO 1i -A
Phone No:.,,,,
Phone No:
Onsite Representative:.S._. - k� Q r Integrator: v P.k_� r-Ar. S
..... r .. .--....
Certified Operator: ................................................................................................................ Operator Certification Number:..........................................
Location "of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� r��s Longitude �• �� ���
Design Current
Design Current _ Degp
=_
Ca aci : Population..
Poultry
_..
CMacity Population' Cattle Ca a . _ ft tiUdon
Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
'LLI
10 Non -Layer
I[] -Dairy
Farrow to Wean
Farrow to Feeder
❑ Other
..
z
Farrow to Finish
`.
Total Design udAay
Gilts
Total L
Byars
Nnniber of Lagoons ❑ Subsurface Drains Present ❑ Lag- n Area Spray Field Area
_Holdpg Ponds /Solid Traps - ❑ No Liquid Waste Management System - y
Discharees & 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)
e. 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 l Structure 2 Structure 3 Structure 4 Structure S
Identifier: ................. ..............................................................................
........... .................................... .............................
Freeboard (inches): Z�
5/00
❑ Yes PNo
❑ Yes gNo
❑ Yes 'Uf No
❑ Yes XNo
C_
❑ Yes XNo
❑ Yes .jNo
❑ Yes RNo
Structure 6
Continued on back

Facility Number: f — j Date of Inspection zIJ Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �J No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONo
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ ExcessivejPon/d�ing ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21 _ Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
::Rio viol'aiioris:oi- def ciencies vt re noted• dtWing this:visit; • Y:oi� 4J11 •receive iio ]further
' ror'respo deice: abaui this visit..... ' . ' . ' ' ...................................
nests (refer to question#): Explain any YES answers and/or any:recom endations or any other comme;
rr-a�wtnt0 of facitity_to-,better explain situations (useyadditional plages as necessary)
ar,,l ( eeGOrGl S GtrG we t kQ.f7.
❑ Yes )dNo
❑ Yes XNo
❑ Yes f No
❑ Yes No
❑ Yes 9(No
❑ Yes P No
❑ Yes 16 No
❑ Yes No
❑ Yes No
❑ Yes ( No
❑ Yes VN0
❑ Yes 1J No
❑ Yes '$] No
❑ Yes �WNo
❑ Yes t5,No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5100

FaciUty Number: -3Date of Inspection I S/ Printed on: 7/21/2000
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ,'Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes $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 XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes —0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings:
5100

Facility Number D�E�pDate of Visit: Z o 00 Time: : oD Printed on: 7/21/2000
O Not Operational O Below Threshold
Permitted [3Certified ❑ Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
FarmName ........... ........j...... ...........r. �............................ Count:........................ .........�................. ............
V
OwnerName:....... Phone No:.......................................................................................
....................................................ff.....................................................
Facility Contact: .................... . e...l..�............ Title:..... ....................... Phone No:...................................................
MailingAddress: .................................................................................. .................................. .....................................%................................................. ..........................
Onsite Representative:...........!...................................:..... Integrator:.......1'[1...........................................................
Certified Operator:.,....-......��. ]..r........................,................................... Operator Certification Number: ................,...............
Location'of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �«
Canarit poniltratin tv •nn
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
;_'4-_' Farrow to Finish
Gilts
Boars
Number of Lragoods ❑ Subsurface Drains Present ❑ LaArea
Holding Ponds / Sold Tcaps: - LO.No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ElSpray 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)
I spray Field Area
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
❑ Yes 1� No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes *14o
❑ Yes ONo
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway (-]Yes A No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �j.. y
0 _...............................................................................................................................................................................................
Freeboard (inches):
5100
Continued on back

Fac' y Number: 3 Date of iiuspection a Printed on: 7/21/2000
Odor Issues WA
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes No"
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes qNo
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 ,ANo
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 A,No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes MNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 040
5/00

[3 'Division of Soil i d�WA r Conservation'; Operation Review
4 -0 Division of Soil and':Waiter Conger*ation.-�Comphance,lhspectron
•�Diviision of Water Quality =Compliance Inspection _ �� w
;- 0 Other Agency Operation Review= 47
_4
-
Routine Q Com taint Q Follow-up ofDWQ inspection Q Follow-u of DSWC review Q Other
Facility Number Date of Inspection 1 IL�T1NI
Time of Inspection 24 hr. (hh:mm)
Permitted 13 Certified 13 Conditionally Certified 0 Registered 0 Not Operational Date Last Operated:
Farm Name: ........`1!-- ,3.......-. ..... C aunty:-......W� 1� ................................................
Owner Name: ..... ...... Phone No:..............................................
Facility Contact: .............................................................................. Title:
MailingAddress: .......................:.............................................................. ...... .... .....................
Onsite Representative: ^!!'5 ................... ..............
Certified Operator:..........
Phone No:......
................. ....................................................
Integrator:...... ..
`►'° ......... �f..
Operator Certification Number:
�o ti of F• � '
.... .... G........ .. .....!:`�5..... ........! C?..........�.......................? 1...................................................,ry..........�..................!"+rJl. Q .......
.....�-............V........ -.............................................................................................................................................................................................
Latitude Longitude �• �` �«
--
,• _ .Deli gnurtDesi n Current Design Current
Ccit„Population„,attlCapacity PouSwine n =
N _ .
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish gLqTe: ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean M.
❑ Farrow to Feeder ❑ Other -
❑ Farrow to Finish = Total Design Capacity
❑ .
Gilts � - •
❑ Boars _
Y.
Total°SSLW " s
Number of Lagoons _ - ❑Subsurface Drains Present 11EILagoonArea ❑ Spray Field Area
Holding Ponds /Solid -Traps �„ „= ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. 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: r�
Freeboard(inches): ........ 4!-5-.............. ................................... ............................. ....... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes b�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
Da No
❑ Yes
C4 No
❑ Yes allo
Structure 6
❑ Yes 5(No
Continued on back
3/23/99

j Facility Number: —'-'/LA I Date (if Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J 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
M 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 ef5No
r
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Xyes ❑ No
3/23/99

Division of Soil and Water Conservation [3 Other Agency
a] Division of Water Quality
0
JfkRoutine O Como Taint O Follow-u of l) 'V ins cction O Follow-u of DSWC review O Other
Date of Inspection
Facility Number { Time of Inspection 24 hr. (hh:mm)
© Registered 1p Certified 0 Applied for Permit © Permitted U Not O erational - Date Last Operated:
Farm Name: ............parsyjv�. s..... st .... Y.Aca...................... ...... County: .... tglSr........................
OwnerName: ........................ -­...1...w .... ���. .............. Phone No: L�i��..G:�'.�s� .... .............................................. .......................................
FacilityContact:...................................:.......................................... Title:................................................................ Phone No:
MailingAddress:....;. 2�,Z,$......oQ+nf�. 0 ..:............................................................. ....+}.:.......N.............................. ....G...
Onsite Representative:.......... ......,, 1q �,�,�, . Integrator:...-... .
Certified Operator; .................................................... .. Operator Certification Number:.................
Location of Farm:
S.i ....
....................................... ................................................ ......
Latitude Longitude ,�• ��«
'Design ... Current
Swine 'Canacity Population
;_.:
... ... . .
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
mA
❑ Farrow to Finish
❑ Gilts
.,
❑ Boars
Design Current Design ` Curr
Poultry Capacity Population Cattle Capacity.. PwA
❑ Layer JEI Dairy
❑ Non -Layer I I0 Non -Dairy
❑ Other
Total Design Capad.fy'
Total SSLW '.
Number of Lagoons / Holding Ponds _ ❑❑ra
Subsurface Drains Present Lagoon Area ❑ Spy Feld airea
TV
❑ No Liquid Waste Management System
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?
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 CgNo
❑ Yes M No
❑ Yes ® No
❑ Yes P No
❑ Yes [Q No
❑ Yes F] No
❑ Yes JA No
❑ Yes M,.No
❑ Yes V No
❑ Yes `P No
Continued on back

Facility Number: 3t —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 0 No
Structures fLagoon%,llolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes [O No
Structure 1 Structure. ? Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (ft). ........11.3..................
10, Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
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)
I5. Crop type ................ .r U.A!A.................................'.". .1.t...�1'C!i'!`-......- ... ...................................................
lb. 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
13 No violations or deficiencie's'werenote'd during this.visit.-.You.will receive no further
correspondence about this.visit'., •
❑ Yes 19LNo
❑ Yes [)4No
❑ Yes No
❑ Yes l� No
Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes No
( Yes ❑ No
❑ Yes T No
❑ Yes Q No
❑ Yes 1� No
Comments (refer to yuestion#) ;Explain anya TS answers and/or any reco�nmendations,or any other cemmen�s
ngs 4._
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7/25/97
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Reviewer inspector Name w,
Reviewer/Inspector Signature: Date:

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSNVC review O Other
Date of Inspection
Facility Number 3 ( 3
Time of Inspection 5 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered [I Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: __..._._ ...... ........ ......... .._..... _ ..... .... __...._ ...................... _ ..... _....._........ ........
z
_.D1Z ` County:......�]�U.�l.lG�. ........ L
Farm Name: x�.��...�...�4�x�.........................._......_...___............ ..........
Land Owner Name:Phone No: .J�O.:..2�r�-
Facility Conctact:..............................._.......................... ....... .............. Title:..................... ........ Phone No:
Mailing Address: 3 f.. PQ"e ... ................. ._._.... .. •.� L.iLL.�. w....� 1� ...... _...._ ..., _��3�.�.....
Onsite Representativ-e:....CLr.! Cam.... 1 Cl.IlC�... _s� l!,.i.:....1 �. Integrator:__S.PAMp hf --- - ----
Certified Operator:.T-ebnny, ........ ...:.._.........� ��,............._.............__..... ..., Operator Certification Number:
Location of Farm:
►^.�Q-rrt:..G s` ...,.as ►a......�5..... .L?i..,......................... _..........................----,..........................------......................................------ ...._.. �y
Latitude ©� 6 " Longitude ©• & u
Type of Operation and Design Capacity
Design Current g Des�g4 Current ; .h Design »Current
Swine�y;x F: Poul tattle' =
act P.© ulatian fir„Y�� ... Ca` act' Po` e�lat�on h:.fi `CaY act P,o„ ulatton
❑ Wean to Feeder r 60-
�:�er
Layer ❑Da'
Fder to Finish La er ❑ Non -Dairy I
Farrow to Wean x � � '
Farrow to Feeder Total Design Capacity Z
3 Farrow_ to Finish f t �
'Total SSL € rx f
z # ❑Other ry �x
�' _..'.� ::•.tea mom; x , 3;..v.
�� x
r
Number of I�agoos /Holding Ponds ❑ Subsurface Drams Present
k..r•� Lagoon Area ❑Spray Field Area
�� � .«::, 5 w ' K ;» fi 9k � N ;+ , s.,2e .,,-ry ` •ic' 2. .€,.,.�, €f. .. .:,�.`i
eneral
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 galhnin?
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?
S- Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes [9 No
❑ Yes ® No
❑ Yes ® No
❑ Yes Ea No
❑ Yes
CR No
❑ Yes
® No
❑ Yes
® No
® Yes
❑ No
Continued
on back

Facility Number:.......... —.......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Iiolftg Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
........3 ...... _. ... ....... W ............ ....... _..... .........
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes JR No
❑ Yes ® No
❑ Yes KNo
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type Ja .k r ............ ...... ......... .._...... ........... ......... ........ .......... ..........
16. Do the receiving crops differ with those designated 2n 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?
24. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ® No
❑ Yes IN No
99 Yes ❑ No
❑ Yes ® No
❑ Yes jo No
❑ Yes Q No
❑ Yes WNo
Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes 10 No
❑ Yes 0 No
Yes ❑ No
Continents (refer to;;questton'; Explain any YES answers and/or any recommendations or any other comments
Use drawmgs;of facility to better explain situations `(use add�t�onal;pages as necessary)
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Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
cc: Division of Water Oualitv. Water Oualitv Section. Facility Assessment Unit 4110197

Site Requires Immediate Attention:
Facility No. Vi-?
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
• DATE: , 1995
Time: 11 X 5
Farm Name/Owner: NN0(` S
Mailing Address:
County: 0. N
Integrator: �[jj ..► jAL t/ Phone: ter
On Site Representative:Phone:
Physical Address/Location: 4.C,59 t 3Q �
Type of Operation: Swine Poultry Cattle
Design Capacity: a'I'L W -h•Bo:,T ° Number of Animals on Site: _ ay y _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3� ° ��' 1')-- " Longitude:-Z°5-'. Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Boor No Actual Freeboard: `( Ft. D Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed?�br No
Is adequate land available for spray? (F�s or No Is the cover crop adequate? Yes or
Crop(s) being utilized: CD44a, I hZpi'►t,�,�w
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellinLy s or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o0o if Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No /
Additional Comments: .4 1 v&4-9 a/1 t- "o't.",( "t
i I-J)r- �r
Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.