310368_INSPECTIONS_20171231

NORTH CAROLINA �
Department of Environmental Qualify

Divi"sion of Water Resources
+Facility Number r , - ��� Division o.f Soil and Water Conservation
s0 Other Age,icy
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (3?Foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access r
Date of Visit: ,t Arrival Time: . ¢j c) Departure Time: ' {�v_ County: Region: �✓�
Farm Name: J 3 i LIGC .uJ""� �— Owner Email:
Owner Name: �, 4G 44 Phone:
Mailing Address:
Physical Address:
Facility Contact: �� � G a"'W t Title: Phone:
d
Onsite Representative: �f Integrator:
Certified Operator: •p t-41.4 Certification Number: T1132j_
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish I 11-ayer I airy Cow
Wean to Feeder I INon-Layer I airy Calf
Feeder to Finish A p00 Dairy Heifer
Farrow to Wean Design I Dry Cow
Farrow to Feeder it P.a Non-Dairy
Farrow to Finish Layers I Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Qther Turke Poults
Other 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 DWR) ❑ Yes ❑ No []"'RA ❑ NE
c. What is the estimated volume that reached waterREd§�6fi I
WR
d. Does the discharge bypass the waste management system?(If yes, notify DWR) ❑ Yes ❑ No [3"NA ❑ NE
2. Is there evidence of a past discharge from any part of the operatWL 0 7 2 017 ❑ Yes [27No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ffNo ❑ NA ❑ NE
of the State other than from a discharge? Water Quality Regional
WilmiOperations Section
ngton Regional Dffice
Page 1 oj3 2/4/20I5 Continued

)
Facili Number: - Date of Ins action: R-ZPF_.
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes �o ❑ NA ❑ NE
a.If yes,is waste level into the structural freeboard? ❑ Yes ❑ No [a"IGA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 33
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 NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWR
7.Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes [✓]No ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E:fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes EfNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes fNo ❑ 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): , .. '`'1.���4 g&U
13. Sail Type(s): 3�,,tt,t,�.� &E,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .[3-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [fNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ED"No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [3]No ❑ NA ❑ NE
Required Records& Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes D-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 [ o ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Cade
❑Rainfall ❑Stacking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1" Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [g/No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [E�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fu�ility Number: - 3 t 8' jDate of Inspection: Wit,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-N-o— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ❑-Ko ❑ 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 aNer ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes [:.I'd'S ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes []-We- ❑ 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 ETNo ❑ 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 [�Ko ❑ NA ❑ NE
permit?(i.e.,discharge, freeboard problems,over-application)
3 I. 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 E3"<o ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑'Ro ❑ NA [] NE
34. Does the facility require a follow-up visit by the same agency? [] Yes [2<o ❑ NA ❑ NE
Commets(refer tagaesti©a#) Explai .a©y'YES answers and/orany add�hoa�liiecominendatioos orAany oilier commentts " t .
Use,drawings of:facility.to better explatnisiitaations:(use`addititinalpagesas
i
5 tUj
L47o
Reviewer/Ins ector Name: r
p �� � Phone:
Reviewer/Inspector Signature: Date: Jd
Page 3 of 3 21412015

• Div'ision of Water Resources
Facility Number 3 - 3d Division of Soil and Water Conservation /
Q Qther Age,icy
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit�0,Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:i/fI/t1//6 I Arrival Time:^imp Departure Time: County: Region:
Farm Name: Rosa, 4 f� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: // Title: Phone:
Onsite Representative: 0,,, ��Y 1�' Cr�/t �i Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C*urrent Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish I ILayer Dairy Cow
Wean to Feeder Non-La er I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Dry Cow
Farrow to Feeder 1), P,oul F Ca aci P,o Non-Da'
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes/EffNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes J�2'No 0 NA ❑ NE
i
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ,❑No I❑ 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 Z No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes-6 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes_JDNG 0 NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - 6 Date of Ins ection: p
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes j] No ❑ NA [] NE
a. If yes,is waste level into the structural freeboard? ❑ Yes VrNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: z--
Spillway l:
Designed Freeboard(in):
Observed Freeboard(in): � ,Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ 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 21 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWR
7.Do any of the structures need maintenance or improvement? ❑ Yes A No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9.Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes V(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 ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes J:�-No ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes Xj No ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes F�f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes '0 No ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements [—]Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes P No ❑ NA C] NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1" Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:] Yes rl No ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

4 Facie Number: -5 - 3g A Date of Ins ection: 1D �/
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 7^ No ❑ NA ❑ NE
25.Is the,facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes Q'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 No ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes _E2'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ff No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30.Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes �No ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31.Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes oNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes PNo [DNA ❑ NE
Comments(refer to question#}:Explain4hy YES`an°savers and/or any additional recommendations:or any.other commenO.�� ;�';_-
Used': awings of facility to better expla ,situahons.(use additional pages as:necessary).:
/''e v,., ves G;Jc7 k r G a d+r�
Reviewer/Inspector Name: y� Phone: -[� 632
Reviewer/Inspector Signature: Date: d A&
Page 3 of 3 2141245

'� i'vision of Water Resources
Facility,Number � - ® OO Division ofi Soil and Water Conservation
Ur.
©Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (!rRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:I q l Arrival Time: Departure Time: County: � Region:
Farm Name: G/CZOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Sl/o//r� _ _ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish I ILayer iry Cow
Wean to Feeder I INon-Layer I i Calf
Feeder to Finish iry Heifer
Farrow to Wean Design Current Wry Cow
Farrow to Feeder 1)—ryj PiouIt Ca a_ci. P,o , Non-Da'
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
keys
Other Turkey Poults
Other 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 .Ej No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ZTNo ❑ 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 Ej No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Zo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: Date of inspection:
Waste Collection&Treatment
4.Is'storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes P3/No ❑ NA 0 NE
a. if yes,is waste level into the structural freeboard? ❑ Yes rxNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ( TNo ❑ NA ❑ NE
(i.e., large trees,severe erosion, seepage,etc.) 7T'
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes VNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWR
7.Do any of the structures need maintenance or improvement? ❑ Yes JZNo ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 EfNo [DNA ❑ 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 ;2r"!4o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dNo [] NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes XNo ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes WNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �jNo ❑ NA ❑ NE
Required Records&Documents T
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. [:] Yes ;5,No ❑ NA 0 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 21412014 Continued

Facili Number: - Date of Inspection:
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes .0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes E!fNo ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes_P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? [:] Yes [DNo ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document [-] Yes �T`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 eNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Vf No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [] Yes Ej No ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments(refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations(use additional pages as necessary).
6j4 fC_
Gu-� �J � O U�rat/l �z r� �Q,C s �a�•
57 �c Cords lZe
t
Pudgy CGP9 ac G'DE C kce15-c
Ot y
Reviewer/Inspector Name: Phone; G U
Reviewer/Inspector Signature: Date: 12-Zz
Page 3 of 3 21412014

J
' Divission of Water Quality
Facility Number © - 3� _ OO Division of Soil and Water Conservation
Q Other Agency
Type of Visit: OCompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: J'Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: — Region:'Va0
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 1 Integrator:
Certified Operator:, �1�p�„r,M �3 �, Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle 0-opy—c—it-VIEPop.
Wean to Finish La er Dai Cow
Wean to Feeder Non-Layer airy Calf
Feeder to Finish Dai Heifer
Farrow to Wean Design Current D Cow
Farrow to Feeder Il . P,oult. Ca aci Po Non-Dairy
Farrow to Finish ILayers I Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow-
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WrNo ❑ 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 ONo ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [;�r`No ❑ NA ❑ NE
of the State other than from a discharge? TT
Page I of 3 21412011 Continued

I '
Facility Number: - Date of inspection:
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? [—] Yes ONo ❑ NA ❑ NE
a.If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): -
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z(`No ❑ NA ❑ NE
(i.e.,large trees,severe erosion,seepage,etc.)
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWR
7.Do any of the structures need maintenance or improvement? ❑ Yes ff No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes [7 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 P?rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
16.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes �2rNo ❑ NA ❑ NE
maintenance or improvement?
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�'No
❑ 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 ff No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes PVo ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VfNo ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes PKNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes PTNo ❑ NA ❑ NE
Required Records& Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes FN o ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑Lease Agreements ❑Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. [:] Yes VNo ❑ 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 0No ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

J
Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;314o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes VNo [DNA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes d
o ❑ 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 PfNo [] NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30.Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ((No ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31.Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes [rNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [XNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes VNo ❑ NA ❑ NE
Comments(refer to question,ft Explain any YES answers 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: 7tts7ti�1 � Phone: r
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

r!
Division of Water Quality
Facility Number - Division of Soil and Water Conservation
OO Other Agey
Type of Visit: 0 Compliance Inspection O Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up ()Referral O Emergency O Other �O Denied Access
Date of Visit: N Arrival Time: ;j Departure Time: County: Region:
Farm Name: &L3A �Jda, i i�� F,VVV \ _ _ _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: {�
Certified Operator: Certification Number: I Wa O
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La er Dairy Cow
Wean to Feeder I iNon-Layer Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean =Qesign Current Dry Cow
Farrow to Feeder Di. P,outt. Ca_ apity P,o , Non-Da'
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers I 113eef Feeder
Boars Pullets jBeef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes CZNo ❑ 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 ETNo ❑ NA ❑ NE
Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes jJrNo ❑ NA ❑ NE
f the State other than from a discharge?
.e I of 3 21412011 Continued

Facifi Number: - Date of Inspection:
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? [] Yes [;2'NTo ❑ NA ❑ NE
aAf yes,is waste level into the structural freeboard? [:] Yes PNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [2rNo ❑ 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 6 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7.Do any of the structures need maintenance or improvement? ❑ Yes F1 No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes VfNo ❑ 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 'EfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11.Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes [;2'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.))
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZI No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes P'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2-No ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes ;Et No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑'No ❑ NA ❑ NE
Required Records&Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes j"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes ;allo ❑ 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 ETNo ❑ 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 ,jE:f No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [allo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r
Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �(No
ff No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes 0 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 6No ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes k(N o ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ff No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit?(i.e.,discharge, freeboard problems,over-application)
31.Do subsurface tile drains exist at the facility?if yes,check the appropriate box below. ❑ Yes gfNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ETNo ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes PNo ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes 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: ���11Q�/ _ _ _ _ Phone: �C^�y�� �
Reviewer/Inspector Signature: Date: r
Page 3 of 3 21412011

' Ojooision of Water E2uality 17
Facility Number 11 - 3(p O Division of Soil and kWa—alerConservation
O Other Agency
Type of Visit: Co pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: dRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Departure Time: County: J UP Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: 1962,0
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C►urrent Design Current Design Current
r5F?ee:Eder
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Finish ' La er DairyCow
Feeder Non-La er DairyCalf
o Finish Dairy Heifer
Farrow to Wean MDTsianUrrent Dry Cow
Farrow to Feeder I) . $oul Ca aci 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 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 j ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

lVacility.Number: 31 Date of Inspection: 6,
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes ff 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 6-raJ 9, LA(tea►.! L-
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): Z$
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ 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 0 No [3 NA [] NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health orZnmYes'roental threat,notify DWQ
7.Do any of the structures need maintenance or improvement? ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑No ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ❑N ❑ NA ❑ NE
maintenance or improvement? 7
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 W�I'o
❑❑ NA ❑ NE
IS. Does the receiving crop and/or land application site need improvement? ❑ Yes
NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes LJ No ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? [] Yes o ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check [3 Yes YNo ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and V Rainfall Inspections Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? [] Yes N ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? [:] Yes No [DNA ❑ NE
Page 2 of 3 21412011 Continued

Facila umber: oil - Sere jDate of Ins ection:
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fNo
�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes [] NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ff No ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C3(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 EkIo ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes E__I 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 131�40 ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ' o ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments(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).
7,) cc,(.A0 tnKC WALL- G-P ot,.r H
GC-r N&w 5LV0 -E SUP-%L•( ro wee
Reviewer/Inspector Name: 7014113 YH R,LX-LV Phone: qlb)7 f 6— 3 yI
Reviewer/Inspector Signature: Date: i (D 7✓
Page 3 of 3 21412011

�,-=�`. � Division of Water Quality
ER141 IS ®Division of oil an Water Gouservation
s0 Other Ageecy
Type of Visit: Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i Arrival Time: Departure Time: County: f�lx Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Ousite Representative: 3?AT?` C4(— :U* S$aA— Integrator: q /
Certified Operator: Certification Number: 1 l bZb
Back-up Operator: Certification Number:
Location of Farm: Latitude: , Longitude:
Design Curren# Design C&uff r,e n t= ent
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish EE
Dai Cow
Feeder La er Dai Calf
Feeder to Finish ?,pis Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Dr. P.oult. C•_a aci P,o Non-Dairy
Farrow to Finish ILayers Beef Stocker
Gilts Nan-La ers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other 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 2 1"U ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes WNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection: )
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 dNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ic'• �o� n„�2
T fir"
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [!fNo ❑ 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 CNo ❑ NA ❑ NE
waste management�or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health orRyles
onmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ No ❑ NA ❑ NE
S.Do any of the structures lack adequate markers as required by the permit? [—] Yes P!(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 Cj No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11.Is there evidence of incorrect land 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 Approved Area
12.Crop Type(s):
13. Soil Type(s):
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E6 o ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes VNo
❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes 2(No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes FZ/No ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes *Wl�o
o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement?If yes,check the appropriate box below, ❑ Yes No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1"Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: /$ 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L!J 1V ❑ 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 ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes EfNo ❑ NA ❑ NE
If yes,contact a regional Air Quality representative inunediately.
30.Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31.Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes [y o ❑ NA ❑ NE
❑Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes < ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes To ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes l Z ❑ NA ❑ NE
Comments(refer to question ft Explain any YES answers and/or any additional recommendations or any,othercdmments`W;
Use drawings of facility to better explain situations(use additional pages as necessary).
7) CL eA N 3 f4 cy-s-zD�_ ° F 1DiLI C WA 4 L-5.
Reviewer/Inspector Name: �� 2N [ Phone( Q 1
Reviewer/Inspector Signature: Date: 6
Page 3 of 3 6011

f.
(- Q Division of Water Quality
tFacility Number - �� Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit RRc uutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I rL� Arrival Time: f QU Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ' -rR_1x l4. ��IS.0 C-.�. Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑c El' El Longitude: [�° [�` [�`4
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
EE
Wean to Finish ❑La er ❑ Dai Cow
Wean to Feeder ❑Non-Layer ❑ DairyCalf
Feeder to Finish 2- ❑ DairyHeifer
❑Farrow to Wean Dry Poultry ❑D Cow
❑Farrow to Feeder ❑Non-Dairy
❑Farrow to Finish ❑Layers
❑Beef Stocker
Po
Gilts Non-La ers ElBeef Feeder
Boars ❑Pullets
El Turkeys ❑Beef Brood Co
Other ❑Turkey Poults
❑Other ❑Other Number of fr—Oct—ur—es-.11111
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes dNo ❑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 [ N ❑NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes No ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

41
I Facility Number: —3 Date of Inspection
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes EZNo ❑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 Gzm) t. LA 6-aopj X
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes ENo ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes U4o Cl 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 environ ental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? 7Yes ❑No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes 9No ❑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 ,�J(
10. Are there any required buffers,setbacks,or compliance alternatives that need El Yes E No ❑NA ❑NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes ET'No ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
[:]PAN ❑PAN> 10%or 10 lbs [:]Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes El No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes ENo ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes EJ/No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application? ❑Yes LTNo ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes [�/No ❑NA ❑NE
Comments(refer to.question#): Explain any YES answers.andlor ao recommendatt. ,.yN , 'ons or°any other commenfs: ,£
Use drawings of facility to better explain situations.(use additional pages.as.neceisary): .
z ._
12-r_Vut ewf CX fl Our Of C 0 &R-PL O cWfrt ►�JREttf PZpE 6;n , R✓C, •
SPL rr A4w&ws oN',S40 060 AMMff1Dr46VT Port 50 Y6S WS ` 64k OW ro
u�f �4,vq+� s ✓C n.s To s� AkHJ ..fit,-{v.>;,0 r(&,
"J sc-4o G n�EAsi C, �4 y f KtsH PARVAIOR-k .
ac
Reviewer/Inspector Name 6 �f�JyiL m Phone: t! ,►�] 11
Reviewer/Inspector Signature: A11141 Date: D
Page 2 of 3 12128104 Continued

,f
Facility Number: —31 Date of Inspection alp
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage& Permit readily available? ❑Yes [ No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes E�No ❑NA ❑NE
the appropiiate box. ❑ WUp ❑Checklists ❑Design El maps ❑Other
21. Does record keeping need improvement?if yes,chec the appropriate box below. D Yes ❑No ❑NA ❑NE
�aste Application ❑ rd [W Weekly Freeboaaste Analysis ❑Soil Analysis ❑Waste Transfers ❑Annual Certification
❑Rainfall ❑ Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and V Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElL�N Yes o ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes dFNo
❑NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? Ef Yes ❑No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? 6Yes ❑No ❑NA ❑NE
27, Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes YN o ❑NA ❑NE
Other Issues �
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes ON'o ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes LiJ No ❑NA ❑NE
and report the mortality rates that were higher than normal? .�
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes E: No ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately �
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes E 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 '1/Nj ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes L`J No ❑NA ❑NE
Additional Comments and/or Drawings:
u
m,
A
A6
Page 3 of 3 12128104

F J0"Dtviston of�WaterQualtty -�4¢y�`•��+ °^i '
rJ - Q � so oloFacility Number D il
an atenu,onset 1110d
Q:Otber�Age cyvyg
Type of Visit �Q'Eo ipliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑Denied Access
Date of Visit: �p D Arrival Time:/����+ Departure Time: County: Region:G✓�
Farm Name: �1�/C/G/ T/�'7 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �Tiitle/:�� Phone No:
Onsite Representative: /l/C�/r1fllf/�L� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e =� =O Longitude: 0° =4 =ll
c- DeSlgn �jll rrenta a g,," 'at'�' yxb- mn " +.�_... g
9 C k Dest n Current Dest n Current
Swine A 'Capac�t}„ Population m We#Poultry .:Capaeity"''Populahott` Cattle '�Capac%ty` Pop�u latton
❑Wean to Finish ❑Layer ❑Dairy Cowc
❑Wean to Feeder ❑Non-La er ❑Dairy Calf
❑Feeder to Finish i„ __ ❑Dai Heifer
❑Farrow to Wean ' } ❑Dry Cow
❑ Farrow to Feeder ❑Non-Dairy
❑ Farrow to Finish t ❑La ers
El El
Stocker
❑Gilts � ❑Non-La Non-Layers
`❑ Pullets ❑Beef Feeder
❑ Boars ❑Beef Brood Cow]
-- �;❑Turkeys
Othe.r,� -; -a ' " ❑TurkeX Poults
❑Other I ❑Other Nurn of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes 140 ❑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 -fNo ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes eNo ❑NA ❑NE
other than from a discharge?
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): �.�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes �No ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes 0 No ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes VNo ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes �No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes A No ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes �No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes No ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑ PAN> 10%or 101bs ❑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 A No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes id No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes T No ❑ NA El NE
17. Does the facility lack adequate acreage for land application? ❑Yes ///�No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes o ❑NA ❑NE
Continents(refer to question#): Explain any-YES answers and/ar anyrecommendateons or-any other commepts v~ � �,
Use drawings of facility to better explain situations.(use additional pages as necessary)
ReviewerfInspector Name Phone:
Reviewer/Inspector Signature: Date: 6zz
P
12128104 Continued

Facility Number:31 13� Date of Inspection G
Required Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes j;'No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes 0'No ❑NA ❑NE
the appropriate box. ❑WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes PNo ❑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 Cade
22. Did the facility fail to install and maintain a rain gauge? ❑Yes EJ"No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes WNo ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes eNo ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes 12/No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes ETNo ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes P No ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes JC2'go ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes ONo ❑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 J No ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes ZNo ❑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 O No ❑NA ❑NE
Additional'Coinments-andlor4D4 Ini gs ' _ �" ` -
�oe
I2l28/04

Q Di�•isian of Water Quality
I acility Number Division of Soil and Water Conservation
+D Outer Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit p4outine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: L U Arrival Time: Departure Time: County: Region:
Farm Name: l Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phones No:
Onsite Representative: �/ /7wt T e r.� Integrator: /Zlo
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=O Longitude: =°
•r
Design Current Design C*urrent Design Current
Swine ,capacity Population Wet Poultryy Capacity Pop lation Cattle Capacity Population
❑ an to Finish ❑Layer ❑DairyCow
❑ an to Feeder ❑Non-Layer ❑DairyCalf
❑Feeder to Finish ❑DairyHeifer
❑Farrow to Wean Dry Poultry ❑D Cow
❑Farrow to Feeder ❑Non-Dairy
❑Farrow to Finish ❑Layers
❑Beef Stocker
❑Gilts Non-Layers ers
❑Pullets ❑Beef Feeder
❑Boars ❑Beef Brood Co
❑Turke s
Other ❑Turkey Poults
❑Other ❑Other Number of Structures: L
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes [/No El NA (I NE
Discharge originated at: El Structure El Application Field El 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 VNo ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ElYes No ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: V— 7Tr 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
Stru ture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes [Ko ❑NA ❑NE
(iel large trees,severe erosion, seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes XNo ❑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 �fNo ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes �INo ❑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/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 l0 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes_O No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes 9KN o ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes P 110 ❑NA [I NE
17. Does the facility lack adequate acreage for land application? ❑Yes IQ No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes J`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):
AL
Reviewer/Inspector Name -; Phone: Z
Reviewer/Inspector Signature: Date: [OZZ.V ZCF
12128103 Continued

• Facility Number: — Date of Inspection
Required Records&Documents ,,......,,//��
19. Did the facility fail to have Certificate of Coverage&Permit readily available? El Yes 9No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?if yes,check ❑Yes FZ No ❑NA ❑NE
the appropirate box. ❑WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes P No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑Waste Transfers ❑Annual Certification
❑Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1"Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes PNo ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes [ZNo ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes V,'No ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes 9.No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes No ❑NA ❑NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes 10 El NA ❑NE
r
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes [ N0 ElNA ElNE
and report the mortality rates that were higher than normal? rr
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes PeNo ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately �1
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes [(d No ❑NA ❑NE
General Permit? (ie/discharge, freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes o ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes No ❑NA ❑NE
h
Additional Comments and/or Drawings m. i u
1
/� 13�G� �f`uGCje
�ee
Page 3 of 3 12128104

AV
0 Division of Water Quality
Facility Number. 0 Division of Soil and Water Conservation
-' — 0 Other'Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: Arrival Time: : V Uf$ Departure Time: County: Region:
Farm Name: �o�.tir� r� C r-P 'A� � Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:A Y1,
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =° Longitude:
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population r
-[]Wean to Finish 10 Layer ❑Dairy Cow
❑Wean to Feeder ❑Non-La et ❑Dairy Calf
❑Feeder to Finish ❑ Dairy Heifer
❑Farrow to Wean Dt'Y PoultryEl Dry Cow
❑Farrow to Feeder ❑Non-Dairy
`❑Farrow to Finish ❑Layers
❑ Beef Stocker
❑Gilts i ❑Non-Layers
❑ Pullets � El Beef Feeder
❑Boars ❑Beef Brood Cowl
_ ._ ❑Turkeys
Other ❑Turkey Poults
❑Other _ j ❑Other T Number of Structures:
Discharges& Stream Impacts ,��
1. Is any discharge observed from any part of the operation? ❑Yes -El 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 4�_No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes O'No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes [:�['1Vo ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: — 4 Date of Inspection S- 3
Waste Collection & Treatment
4, Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes L'No ❑NA ❑NE
a. If yes,is waste level into the structural freeboard? ❑Yes 0-No ❑NA ❑NE
Strur 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
s
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes Q No ❑NA ❑NE
(iet large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [:�'No ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ❑No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes a No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes 2-No ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes J:�No []NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes J�klo ❑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 ;ET-No ❑NA ❑NE
15, Does the receiving crop and/or land application site need improvement? ❑Yes Jallo ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑Yes [3'No ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes .12Ko ❑NA ❑NE
t
18. Is there a lack of properly operating waste application equipment? ❑Yes P[o ❑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):
G/l!- O Ylslo� SL c Su/vim 3� r�_ Po 5",4 > � `
C"' b e Slt� aL t oy,,
e�4o r-�.5 4v -e 1 t `^3'c2d S L V�
IS E Y
Reviewer/inspector Name Phone: 7- Z
Reviewer/Inspector Signature: Date:
12128101 Continued

� Division of Water Quality
• Division of Soil and Water Conservation
?Facility Number _ �j O
Q Other Agency
Type of Visit JO-Co-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l Arrival T e: �� Departure Time: �� County: Region:
Farm Name: 2Z C Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title. Pho a No:
Onsite Representative: Integrator: M"/_/_5
Certified Operator: Operator Ce ification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ° =6 Longitude: °
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish I IE]Layer ❑Dairy Cow
❑Wean to Feeder I 1E]Non-Layer I Dairy Calf
Feeder to Finish ❑Dairy Heifer
Farrow to Wean Dry Poultry ❑Dry Cow
❑ Farrow to Feeder ❑Non-Dairy
❑ Farrow to Finish ❑La ers
❑Beef Stocker
❑Gilts ❑Non-Layers ❑Beef Feeder
❑ Boars ❑Pullets
❑Turkeys ❑Beef Brood Cowl
Other ❑Turkey Poults
❑Other M❑Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes [Ko ❑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 ff—No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes [5-No ❑NA ❑NE
other than from a discharge?
Page I of 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 AD-No ❑NA ❑NE
a. If yes,is waste level into the structural freeboard? ❑Yes E3'No ❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): Ze
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes J: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 WNo ❑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 [;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 PKNo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes [ kNo []NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes �No ❑NA ❑NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
[:] PAN ❑PAN> 10%or 10 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes [>No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes [�No ❑NA ❑NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes P_No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes rNo ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes ONo ❑NA ❑NE
Comments(refer to question.#): Explain any YES answers and/or any recommendations or any,other comments t I
Use.drawings of facility to better explain situations.(use additional pages as necessary)- Jr
7
Reviewer/InspectorName - Phone: '�a
Reviewer/Inspector Signature: Date:
Page 2 of 3 1 128/04 Continued

Facility Number: — Date of Inspection
Required Records&Documents 7T`
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes P-No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes �No ❑NA El NE
the appropriate box. ElWUp [I Checklists ❑Design [I Maps ❑Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes ❑No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑Waste Transfers ❑Annual Certification
❑Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and V Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes J2 No []NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ZNO ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No "NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑No P NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes ONo ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ❑No ❑NA WIM
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes _L3-No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes gNo ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes E(No ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes ETNo ❑NA ❑NE
General Permit? (ie/discharge,freeboard problems,over application) ,_,{
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? El Yes LJ No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes VNo ❑NA ❑NE
Additional Comments and/or Drawings:
716 z
Pa�) �_, z
f,-z vs C ) l` y
�r '2
Page 3 of 3 12128104

Division of Water Qual9ty
Fac}'amity Number 6 Division of Soil and Water Conservation
Q Other Agency
Type of Visit Q<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ergoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: G Arrival Time: `�.'OCR Departure Time: County: DC44Z Regio61
nhl r
Farm Name: �-�./l i e���- r--� ' 4Imo' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: &C Integrator:
Certified Operator: Operator Certification:2.ber:
Back-up Operator: Bach-up Certification Number:
Location of Farm: Latitude: o Longitude:
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑Daia Cow
❑Wean to Feeder I IE]Non-Layer I I ❑Dairy Calf
Feeder to Finish I 2-Y21 d YO0 1 ❑Daia Heifer
EI Farrow to Wean Dry Poultry EfDry Cow
❑Farrow to Feeder El Non-Dairy
El Farrow to Finish ❑Layers
El Beef Stocker
❑Gilts ❑Non-Layers
El Pullets El Beef Feeder
El Boars ❑Beef Brood Cowl
- - - ❑Turkeys
Other ❑Turkey Puuets
❑Other ILI Other Number of Structures:
Discharges& 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 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 eNo ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes �eNo ❑NA ❑NE
other than from a discharge?
12128104 Continued ,

Facility Number: ' - 6 Date of inspection
Waste Cbllection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes -E!TNo ❑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?: l _
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes Fe-Mo ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes 2`No ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L:i 10 ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;`No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes .2'No ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes ONo ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes „ONo ❑NA ❑NE
❑Excessive Ponding ❑ Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑PAN ❑ PAN> 10%or 10 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window El Evidence of Wind Drift/❑Application Outside of Area
12. Crop type(s) UPS/�22 C,0 -- ---
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes ❑No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes ❑No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑Yes ❑No ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes ❑No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes ❑No ❑NA ❑NE
_ i� c ifx E. �."9,
Comments,(refer to question#) E lam`aoy YES answers and/or,any recommendations or any oth6f,, o6m`inents h¢
' x r
.LJse drawings of facihty to better explain sttuattons c(useadillhonallpgagastnecessary,)
Reviewer/Inspector Name w Gam/ Phone: 9- 7
Reviewer/Inspector Signature: Date:
i2lmlol Continued

Facility Number: — Date of Inspection o
Required Records& Documents
�N Did the facility fail to have Certificate of Coverage&Permit readily available? ❑ Yes D No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes &No ❑NA ❑NE
the appropirate box. ❑WUP ❑Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. eyes ❑No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Annual Certification
V Rainfall ❑ Stocking ❑Crop Yield FFI20 Minute Inspections Monthly and V Rain Inspections 'Ferweather Code
22. Did the facility fail to install and maintain a rain gauge? J2*Ves ❑No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes 0'�o ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No .-NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑No ONA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes FKo ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ❑No ❑NA Z NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes j2NNo []NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes J:1-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 f,_�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? (ie/discharge,freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes-.21 No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes E1No ❑NA ❑NE
Additi6oalt6inments and/or Drawings:
l2/28/04

.."r'"
Type of Visit Co liance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number Date of Visit: LThne:QoO nal O Below Threshold
Ef'Permitted Certified ©Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ..... . . .._. ....
FarmName: ............................._..............................................................................-.... ........ County: .........UVOW................................
OwnerName: _. ........ ................... Phone No: .......................................................................................
Mailing Address: .. ._ . ._. ._._....... .
Facility Contact: Title: _ -- ... .. Phone No:
y� J
Onsite Representative: .. ` fl _lk�AL�........................ Integrator:
Certified Operator:............................................. ............................................... Operator Certification Number:..............................._�._....
Location of Farm:
❑Swine ❑Poultry [3 Cattle ❑Horse Latitude �•�� �« Longitude �• �� �«
Dgn` Current' Desiiga Current=�� — Design Current'
__ - _ a
Swine ,Ca`acr twP4'ulatton „_PoWtry_ �Ca`aci x.Po'eilation,,e Cattle .___ Ca aci =Po ul tton
"-❑Wean to Feeder ]Layer ❑Dairy -
eeder to Finish no
�=;[]Non-Layer I Ij]Non-Dairy
Farrow to Wean
?❑Farrow to Feeder Other
Farrow to Finish Total Design Apacty,
Gilts
❑Boars f ,_ Total`SSLW'
�. W
k 5 Number of^Lagoons Y
i sx ss Irv.
Discharges&Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes ENo
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 ET No,
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes <0
Waste Collection &Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: I. ........ .............�......----_ ---..------------_------._- ................................... ................................... ...................................
Freeboard(inches):
12112103 Continued

Facility Number: Date of Inspection
5,.Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes O/NNo
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑Yes 0 No
closure plan?
(If any of questions 46 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenancelimprovement? Er'Y' es ❑No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑Yes Q No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level ❑Yes �4/0
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑Yes [1N0
11. Is there evidence of over application? If yes,check the appropriate box below. ❑Yes No
❑Excessive Ponding ❑PAN ❑rrH,,,ydraulic Overload ❑Frozen Ground ❑Copper and/or Zinc
12. Crop type Ge_Q_NUj)A (6 g,0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes o
14, a)Does the facility lack adequate acreage for land application? ❑Yes QNo
b)Does the facility need a wettable acre determination? ❑Yes 644101
c)This facility is pended for a wettable acre determination? ❑Yes L o
15. Does the receiving crop need improvement? ❑Yes [k/o
16. Is there a lack of adequate waste application equipment? ❑Yes 13 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑Yes CJ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑Yes QN10,
19. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes 9X
roads,building structure,and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes,contact a regional ❑Yes [ io
Air Quality representative immediately.
�Comreients-(refer to gneshon�) Explarn aay Y1�S answeis aadlor aay iecommendatioas o�r�aay ot�e�r�comments. � � _�=- x r
`Use drawings of facility to betterexplarn sitxmt�oas.(ntse addi�cnal pages as aeoessary) ,�❑Field Copy ❑Final Notes
1 V1/00 A9AWD LAGmrJ I AU-S, owNI R, A 1(-rG AVee- ?R.onyuE�'^ (&4vi
LACE 1 23. LAST WASTE 0AU5 Z5 7111103 g103 51o4
w>21C on/ l,.w6eDS I0 J.xc4D. e_XAjA2Ama1 56EMS
T
Reviewer/Inspector Name t ,�-- - ..
Reviewer/Inspector Signature: Date: G
12112103 Continued

Facility Number: — X Date of Inspection 1
44 r
Required Records &Documents
21. Fail to have Certificate of Coverage&General Permit or other Permit readily available? ❑Yes ErNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes o
23. Does record keeping need improvement?If es,check the appropriate box below. 3' es ❑No
❑Waste Application ❑Freeboard Waste Analysis ❑SoiI Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes
25. Did the facility fail to have a actively certified operator in charge? ❑Yes VNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit? /
(ie/discharge,freeboard problems,over application) ❑Yes C4
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? El Yes7No-
29.28_ Does facility require a follow-up visit by same agency? ❑Yes Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes o
l`rPUES Permitted Facilities
30. Is the facility covered under a NPDES Permit?(If no,skip questions 31-35) ❑Yes No
31. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑No
32. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑No
33. Did the facility fail to conduct an annual sludge survey? ❑Yes ❑No
34, Did the facility fail to calibrate waste application equipment? ❑Yes ❑No
35. Does record keeping for NPDES required forms need improvement? If yes,check the appropriate box below. ❑Yes ❑No
❑Stocking Form ❑Crop Yield Form ❑Rainfall ❑Inspection After 1"Rain
❑ 120 Minute Inspections ❑Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddittonal CornmentS�ani&'r'Dcavuirlgs
L
12112103

r
Division of Water Quality
0 ivision of Soil and Water Conservation
0 Other Agency
Type of Visit 6COmpliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit aRoutine O Complaint O Follow up 0 Emergency Notification 0 Other ❑Denied Access
Facility Number Date of Visit: �Time:
rO Not Operational 0 Below Threshold
Permitted ®Certified E3 Conditionally Certified [3 Registered Date Last Operated o Above Threshold:
Farm Name: _ i!X 11-le- /M /�z County: a ern
Owner Name: � Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: �U✓101t 5�
Certified Operator: Operator Certification Number:
Location of Farm:
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude 0+���u Longitude
Design Current Design Current Design Current
5w_ine Ca aci Po ulatian $oul_t_ry Ca aci P,o ulation Cattle Ga aci P,o Marton
❑Wean to Feeder ❑Layer ❑Da'
Feeder to Finish Z 1 ❑Non-Layer ❑Non-Dairy
❑Farrow to Wean 21
❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity
❑Gilts
❑Boars Total SSLW
Number of Lagoons 0 ❑Subsurface Drains Present ❑Lagoon Area I0 Spray Field Area
- -
Holding Ponds/Solid Traps ❑No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes ®No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ❑No
b. If discharge is observed,did it reach Water of the State?(If yes,notify DWQ) ❑Yes ❑No
c. If discharge is observed,what is the estimated flow in gal/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 ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes ZI No
Wash Collection 8&Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes ®No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / Z
Freeboard(inches): Z7
05103101 Continued

Facility Number: �7 — Date of Inspection I lA 10
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes &rNo
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ®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 [:1 No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes ®No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes K]No
11. Is there evidence of over 1 application? / El Excessive Pondii/ng ❑PAN
/� ❑Hydraulic Overload ❑Yes ®No
12. Crop type ��Avt 4 A ! trr/�! :j2 Gi ��:n 1JJ!'�'e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes R]No
14. a)Does the facility lack adequate acreage for land application? ❑Yes ®No
b)Does the facility need a wettable acre determination? ❑Yes El No
c)This facility is pended for a wettable acre determination? ❑Yes F1 No
15. Does the receiving crop need improvement? ❑Yes E�No
16. Is there a lack of adequate waste application equipment? ❑Yes ®No
Required Records&Documents
17. Fail to have Certificate of Coverage&General Permit 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 [ZNo
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) Yes ❑No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ®No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes tQ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes ®No
23. Did Reviewer/inspector fail to discuss review/inspection with on-site representative? ❑Yes ®No
24. Does facility require a follow-up visit by same agency? ❑Yes N No
25. Were any additional problems noted which cause noncompliance of the Certified AWW? ❑Yes ®No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comm�niits(refer to.question#) Faplam any 1�ES answers andlor_any recoutmendahons or any W. other.coinments"
Use drarvtngs of facility to better a phut sttuattons se additional pages as,neeessaq) ❑Field Copy ❑Final Notes
r v :
C��vpon z :� G,"�- /"/ is ct Z7 fv �e
Z4>41 i'P�/C ih OZ Q,`�s+P� 4i , 11f►,P1-17 eat I'gfl C� Adl l gec�L�'(iGc�S ar �i'vR� S'Sd
p fV os— Z cf"Al,
Oe,j, f',, 7-15'O1 -/te on was M �ZG. �o'cc ✓ra11�,� was �c
011 &)/G v— AVe PAi 5 AV Cu rvlm t res I//f 7v Z,.4/ck kle Xo�p D/4 rer�l, pe" us��
Reviewer/Inspector Name ; ..
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: 3/ —3Gg Date of Inspection 0 D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑Yes ®No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes ®No
28. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes 19 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 S 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 •1�1 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes C9 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes 81 No
Additional Comments and/or Drawings:° 3.
fh 5 A-A eS fl l- 4 o s6<si , i /hr !S S� �t t
Aw way -6eee,41.
e ✓ey-
O5103101

ODivision of Water Quality
Q Division of Soil and Water Conservat<on. -:
r' Q t7ther Agency
E
f Visit CJompliance Inspection Q Operation Review O Lagoon Evaluation
n for Visit ft7 Routine O Complaint O Follow up Q Emergency Notification 0 Other ❑Denied'Access
Facility Number
Date of Visit: Z �� Time: I�L .J Printed on: 7/21/2000
1 6
0 Not Operational Q Below Threshold
,EfPermitted ©Certified J3 Conditionally Certified ❑Registered Date Last Operated or Above Threshold: .........................
Farm Name: . �.r rL� O! rAf'�'.. Z County. �.: ... .............................. ...........
- . �.....j........................................... I r rf
OwnerName: P....Q ... �1r7.. .. . . ................................................... Phone No: .......................................................................................
................... .......
FacilityContact: ..............................................................................Title: ................................................................ Phone No: ...................................................
MailingAddress: ... .................................................................................... ..................................................................................... ..........................
Onsite Representative: �DDI. 1-� .rT 1 e l .......... Integrator: �Y� .....t'] ....................................................
............................................................. ...............
Certified Operator:....................._............................. ......................................._..................... Operator Certification Number:..........................................
Location of Farm:
rA,
Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude �•�� ���
Design Current Design Current Design Current
>' Ca ci Po ulation Poultry Ca act Population Cattle Po tioa
Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish ❑Non-Layer I 1 ❑Non-Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design"Capacity
Gilts
Boars Total SSLW '
Nter;af Lagoous ❑Subsurface Drains Present ❑Lagn Area ❑Spray Field Area
H
aiding Ponds]Solid Traps
10 No Liquid Waste Management System
Discharges&Stream Im acts
1. Is any discharge observed from any part of the operation?
❑Yes No
Discharge originated at: [ILagoon [ISpray Field ElOther
a. If discharge is observed, was the conveyance man-made`? ❑Yes 'La"No
b. if discharge is observed.did it reach Water of the State?(If yes, notify DWQ) El Yes 'PINo
c. If discharge is observed, what is the estimated flow in gal/min? P?IOl
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 JZINo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes 9No
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes ErNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................... ...
................................. . .................. .. .................................... ....................................
Freeboard(inches): Z f ZD
5/00 Continued on back

Facility Number.3 1 — -?Cql Date of Inspection Z 0 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 XNo
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes JOINo
(if any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? Xyes [:]No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes'J�No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes No
Waste Application //
10. Are there any buffers that need maintenance/improvement? ❑Yes X No
11. Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Hydraulic Overload ElYes
12. Crop type )ZrNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes XNo
14. a)Does the facility lack adequate acreage for land application? ❑Yes ❑No
b)Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? Yes ❑No
16. Is there a lack of adequate waste application equipment? ❑Yes ZNo
Required Records&Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes .01No
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 ONo
19. Does record keeping need improvement?(ie/irrigation, freeboard,waste analysis&soil sample reports) OYes ❑No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes )YNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems,over application) ❑Yes/ZfNo
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on-site representative? ❑Yes YfNo
24. Does facility require a follow-up visit by same agency? ❑Yes ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes o
�'Vo vioiati9rKor•it. clendes were noted during this:visit=•Y:ou will-receive iio Fuit#►er
orieso inide i . .about.this visit. .
Comments(refer to question ft'Explain-any YES answers and/or any recarnmendahons,or any'other comments
Use"dr-AV in-&..of-faciIity._to better'gxpWn,situations.(use additional pages as necessary)
, -
Igcts 6e.e" do-ie -v r4-^,ove 4.•ees -r<fo,�. �q�orn-, i�,a61 s� gopd ab A�
w C-11C esfabl:sL, Sr�SS Gov2r' on 6�fe q�C�as; r�^�(e era ec
q,reet.s cis w 4/ ai­�4 ej fQ 61; 9 rass.
1� work f� ; P��>< e Coma! �errtvd�l -:4,q
19 . `Take sB;f s� Jes For each �;eldl 1e�s o.-1ce a r?atr-.
W .1q �,`1 d4jad wi %n (a4 ca�j'a c;ver Son
4 ki e TO S ' e s-le le le s Q rr5 ce
Reviewer/Inspector Name SO✓1 1..�G1 1V�.>_` - _ : 1
Reviewer/Inspector signature: Date: qLz o 5/00

Facility Number: Date of Inspection Z A Printed on: 10/26/2000
Odor Issues
26."Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑Yes ❑No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yeso
28. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes/)eNo
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 )i 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/4:�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes -C^o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes ❑No
Additional otnments an orDrawings: (( be, _
Nofe add[ -f ► e�� z i-l1L D 4-tiQ ln�q�e- rIa T►-N ]-F � rs Jo VS24401/'
5100

D1V151on of Water Qtiallt}r5.
r �T„
014
.Dlvlsion of Sotl and Water Cooservatlan
u Q_Other Agency
= 44
r -
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ElDenied Access
Date ut"`isit: 1/O Time: -O
Facility>�Tumber =ZtPrinted on: 7/21/2000
Q Not Operational Q Below Threshold
O- '..:!Permitted © Certified [3 Conditionally C/eyrttified Registered Date Last Oper or Above Threshold
Farm Name: ............. �... . I +� r .. Count`: ..............1;�: �_
..................•. _.................. -
p
Owner Name: ............ ..............
............ .. ....... .................................... Phone No: .......................................................................................
Facility Contact: .......... .... .................Title .P&t:..!' I ..... Phone No: ...................................................
MailingAddress: ...-.... .............................................. ..........................
1 -
Onsite Representative: ...........4. 1
1�V (.......................................................I Integrator:.....-......-+.,L,r,-
...........•..............................................
Certified Operator:...............•--....................... Operator Certification Number:............
Location of Farm:
Swine []Poultry ❑Cattle ❑Horse L<<titude ` Longitude �• �4
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑Wean to Feeder ❑Layer EEI Dairy
Feeder to Finish H(� ❑Non-Layer Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity
❑Gilts
❑Boars Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑Lag—)n Area ❑Spray Field Area
Holding Ponds/Solid Traps ❑No Liquid Waste Management System
Discharges &Stream Im acLS
I. Is any discharge observed from any part of the operation? ❑Yes [XNo
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance nian-made? ❑Yes ❑No
b. If discharge ie 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 galhmn? —.A—
d. Does discharge bypass a lagoon system'?(if yes, notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes *o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑Spillway [:]Yes [KNo
Structure I Structure 2 Structure Structure 4 Structure 5 Structure 6
Identifier. .-•---..2 ....... ................ 1�...... ................................... ...................................... .......................--........... ....................................
Freeboard(inches): ttt
5100 � } � �� Continued on back

acilitf Number: "50 ADate of Inspection Printed on.• 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obse ved? ie/trees,severe erosion, ❑Yes �No
seepage,etc.) ''��-
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ANo
(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 4NO
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑Yes P-140
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes 0No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes XNo
11. Is there evidence o ov r applic i ? El Excessive Ponding ❑PAN ❑Hydraulic Overload El Yes gNo
YP
12. Croptype 3�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes AND
14. a)Does the facility lack adequate acreage for land application? ❑Yes 9�No
b)Does the facility need a wettable acre determination? ❑Yes XNo
c)This facility is pended for a wettable acre determination? ❑Yes -5;rNo
15. Does the receiving crop need improvement? ❑Yes No
16. Is there a lack of adequate waste application equipment? ❑Yes No
Required Records &Documents
17. Fail to have Certificate of Coverage &General Permit readily available? ❑Yes 4No
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 VNo
19. Does record keeping need improvement?(ie/irrigation,freeboard, waste analysis&soil sample reports) XYes ❑No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes M�'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application) ❑Yes 6No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes No
24. Does facility require a follow-up visit by same agency? ❑Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes fkNo
10 Yiola�ions:or deficiencies were h0ted.diwift�his•vislt--Yoir will-r,eegiye Rio;futft I
ivories oridence:about this visit
Epmmeflts{refer to question#): Explain.any-YFS answers and/or any:recommendations or any other,co nts
Use drawiregs„of fa©city to-better explain situations.(use additioiiial pages as necessary)e
Reviewer/Inspector Name 'Lim r
�.
Reviewer/Iaspector Signature: Date: S/pp

Faciffty Number: Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below kYes ❑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 tNNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation,asphalt, ❑Yes o
roads,building structure, and/or public property) AN
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑Yes KNo
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 �UNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes/eNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? VT'es ❑No
Additional omments an orDrawings:
. I -
i
ld4'
S
5100

-- :A Di OUion of Water Qoality`
Q Division of Soil and Water_Conservation ;
„ T = O`Utlier Agency_ -
Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification XTOther ❑Denied Access
Facility Number 3] Date of Visit: Z 10 0 Time: Printed on: 10/26/2000
Q Not Operational O Below Threshold
'Permitted © Certified ©Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name c ;c�r�...FAY v......14—L County: PV�li`'�.........................
................ .............................. . ........... ......... ..............
Owner Name: r" +¢
, Phone No:
l a .........�a........`.....! .........................................I............. .......................................................................................
FacilityContact: ..............................................................................Title: ................................................................ Phone No. ...................................................
MailingAddress: ....................................................................V................................................ ..................................................................................... ..........................
Onsite Representative: �f 1td I'/��Ejp kn � l� Integrator .m v 'ter le" S'
7 ............ti..t ..........�.....................ar e............... ��J. . .............................................
Certified Operator:................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
w
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude �'�° ��� Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑Wean to Feeder ❑Layer ❑Dairy
❑Feeder to Finish ❑Non-Layer ❑Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity
❑Gilts
❑ Boars Total SSLW
Number of Lagoons Z ❑Subsurface Drains Present 1111 Lagoon Area ❑Spray Field Area
Holding Ponds/Solid Traps ❑Na Liquid Waste Management System
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes ❑No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑No
h. 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 ❑No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes ❑No
Waste Collection &Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes VNo
Structure 9L tru•t re 2 Structure 3 Structure 4 Structure 5 Structure
........... ... .......... ..................... 6
Identifier: ...............�'�1 T... `.�.� ................................... .................................... .................................... ....................................
. . .
Freeboard(inches): 2 -2Z
5/00 Continued on back

Facility Number:'3) —3010 Date of Inspection d d Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes ❑No
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ❑No
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑Yes ❑No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑Yes ❑No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes ❑No
Waste Application
10. Are there any buffers that need maintenance/improvement? Yes ❑No
11, Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Hydraulic Overload ❑Yes ❑No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes ❑No
14. a)Does the facility lack adequate acreage for land application? ❑Yes ❑No
b)Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes ❑No
I6. Is there a lack of adequate waste application equipment? ❑Yes ❑No
Required Records & Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes ❑No
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 ❑No
19. Does record keeping need improvement?(ie/irrigation, freeboard,waste analysis&soil sample reports) ❑Yes ❑No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ❑No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes ❑No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes ❑No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes *0
24. Does facility require a follow-up visit by same agency? ❑Yes ❑No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ❑No
Yiol'a�igris:oi-deficiencies were noted it0ifui Ns'vi* t;-Y;oil will-teeeiye lid lrui•ther
icorres onceiRce.a�ou7 this.visit.
Comments(refer to question#) Explaib any YES answers and/or any recommendations or any_otherncomments
Use drawings of facility to better explain situations,(use additional pages as necessary}
r'-►o+�:-for sera y i►1 Ac-�;
rB . �ra w�,r ��� S,prq�e0{ ��,r o ss a �,'�G� q.�� SOmC [.,aa sTe. i S • �. T�e
d►` L� . G r o L--c e, li c ed s 4o :5-0 g v h -Miet f amt D o od
tv qs4 e a. pear S ?G pe GS►� ati e� .
Reviewer/Inspector Name &::''f e vic t ",]} �! J
Reviewer/Inspector Signature: Date: 5/00

a-nd' ter Operation Review
13 Division of Soil
0 &�iati6ji�-Colnapliance I& ection
13 Division of SiAl and Water Cons _p
11 Division of Water.6iiiqcon �iance insecti onp
'Other Agency-.0peratiow W_1_,.,_ ,
e
13 R'ev]
M,
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 Date of Inspection rJ
Time or Inspection E21j=24 hr. (hh:mrn)
M Permitted [3 Certified 0 Conditionally Certified [3 Registered JE3 Not Operational I Date Last Operated: .....................
I
Farm Name: ......... 72� County: _Pyhn .. ... ......... ......1­1.1......... I......................
. ................
Owner Name: ........!` .d....... LA, ....... ........................................... Phone Nd .11) 3�Z ?
......... ........1­1.........I.......I.................
FacilityContact. ..............................................................................Title: .11....................... ................................ Phone No: ..................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative. k -Y) _F
....................................... .......................................................... Integrator:..... ............................................
...7......F
Certified Operator:.................................................. ............................................................. Operator Certification Number:..........................................
Location of Farm:
Ak
............................................ ...........................................................................................................................................................................................
.................................................................................................................................................................................................................. ......
Latitude 0=1 Longitude =0
"—D ign Cuitieint "'_ Desi'n Ctiiient
Design Current
9
Swine -Capacity Population'- Cattle Capacity P0
Capacity Population Capaci pulatio
❑Wean to Feeder JE]Layer I[]Dairy
D Feeder to Finish IF]Non-Layer I JE1 Non-Dairy
[I Farrow to Wean
❑Farrow to Feeder ❑Other
------❑Farrow to Finish Total Degi CaPa7
I U- Design dty
❑Gilts
[3 Boars TotaLSSLW
Number of-Ligoons. ❑JEI Subsurface Drains Present J�ago�onAre- P Spray Field Area
HoldifigPon& Solid Traps No Liquid Waste Management Sys!!!!L____j
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation? X Yes [I No
Discharge originated at: []Lagoon C]Spray Field NOther
a, If discharge is observed,was the conveyance man-made" El Yes V No
h. If discharge is observed,did it reach Water of the State?(If yes, notify DWQ) ❑Yes JR 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) CK Yes El No
2. Is there evidence of past discharge from any part of the operation? El Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? E]Yes JD.No
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? 0 Spillway E]Yes E]No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 .
Identifier:
Freeboard(inches): ................................... ................................... .................................... ................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, D Yes E]No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 f — Date of Inspection
6. Are t1wre 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 maintenatice/improvement? ❑Yes ❑No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes ❑No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes ❑No
11. Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑ Yes ❑No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑Yes ❑No
14. a)Does the facility lack adequate acreage for land application? ❑Yes ❑No
b) Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? ❑ Yes ❑No
15. Does the receiving crop need improvement? ❑Yes ❑No
16. Is there a lack of adequate waste application equipment? ❑Yes ❑No
Required Records & Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes ❑No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WCIP,checklists,design,maps,etc.) ❑Yes ❑No
19. Does record keeping need improvement?(ie/irrigation, freeboard,waste analysis&soil sample reports) ❑Yes ❑No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ❑No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes ❑No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application) ❑Yes ❑No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes ®No
24. Does facility require a follow-up visit by same agency? ❑Yes ❑No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ❑No
�:Rio-yiolafidiis;ot-deficiencies were noted-OtWitig•this:visit'.•Yoi.t'Will•reeeive Rio further
corres oridehce:abou>k this'-visit:•.•.•.•.•. . . . . . . . . . . . . . . . . . . . . . . . . . .
Comments_(refer'to question#): Explatn any YFS answers a�irVor any recommendations or;any.other comments, s
Use drawings:of facility to-better-explain situatiois (use additional pages as necessary):z
I • �l s-r` i I .57 -i 1 j 1 q f n�.�-� �a ho t.`Se . 6 w P}tr- neeo4 S �d `
en016­� �ef�Llatn�► i S,o J .� ) ,�, +a s- B� ► -{� -eYd,,?�
O
7. Gj1Gt� UJct� `S r�o��p[ +vbf..��Qj TG ol� I"4�2Y
9 r�asS vQ'Se-4-i�iaY) .�Lt oll ld 6e ItSA e d do eY7+;/ ��` 1®L,47,&
Reviewer/Inspector Name F Td ►'l4't'V�i � 9. S � e s
Reviewer/Inspector Signature: Date: ZS
3123/99

<.. ©Division of Soil and",Wafer Conseryat<on"»Operation Revi'_
.,
E Division of Soil and Wat6FConservation=Compliance Inspection
('Division of Water QualEty '„Com$l�ance Inspection
r r _1]©ther Agency Opera '&n_Review;
Q Routine Q Complaint ® Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number / 3 6 Date of Inspection
Time of Inspection /34Q 24 hr. (hh:mm)
(LPermitted ©Certified © Conditionally Certified [3 Registered [3 Not Operational Date Last Operated:
Farm Name: qo d 13G r f 1 N Fi1"m* --)— County: "-�U /;r .....................
....�•••".--...... .-•---...-"---".................................................................... ..--....-..-..........-"---...............
;e1 /� a } / �Q - 3707
Owner Name: ........ ....1(r!L....................'!. 1.......................-.............-................-........ Phone No: ..`,-1..1./-..SO C7
FacilityContact: ......-.1-,.3. ...................................................Title. ................................................................ Phone No:
Mailing Address: su-wt m e r'I/n (reSStOOt�f f,Q/, f ie A V G.............. _.0 3 65
..........................'............I...I......I................ 4 .....!--:1-....- ... ... .. ....... .....
Onsite Representative '.. .......T.h.. �T}.k`lyet,!,. ..�:`'..i�.:r.GWntegrator:...'.--.`Ur�� ...............................................
Certified Operator:................................................... ............................................................. Operator Certification Number:.................-. ........................
Location of Farm:
............................................................""----.-..........---.......................................................................................................................................I—............................... �
Latitude �° 0•' Longitude • �' �"
Design Current, Design: Current Design Current
SWine. ulfiY Capacity.Population Cattley Po elation Capacity Population
❑Wean to Feeder ❑Layer ❑Dairy
❑Feeder to Finish ❑Non-Layer ❑Non-Dairy
❑Farrow to Wean
❑ ❑Other
Farrow to Feeder
❑Farrow to Finish - Total Design Capacity
❑Gilts
❑Boars -- Total SSLW
` Number-af'Lagoons 1 2-- j ❑Subsurface Drains Present ❑Lagoon Area I0 Spray Field Area
HoldingPonds/Solid Traps �n Ar [I No Liquid Waste Management System
,.
Discharges&Stream Impacts
1. Is any discharge observed from any part of the operation? $9 Yes ❑No
Discharge originated at: ❑Lagoon ❑Spray Field 10 Other
a. If discharge is observed,was the conveyance man-made? ❑Yes M 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`? seep49 e-
d. Dees discharge bypass a lagoon system'?(If yes, notify DWQ) 10 Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes ❑No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage)Iess than adequate? ❑Spillway ❑Yes ❑No
Structure ] Structure 2 Structure 3 Structure 4 Stricture 5 Structure 6
Identifier:
Freeboard(inches): ................................... ................................... .................................... ................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, Yes ❑No
seepage, etc.)
3/23/99 Continued on back

Facility Number: :?I —.3� Data•of Inspection r] 22
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? 19 Yes ❑No
8. Does any part of the waste management system other than waste structures require maintenahce/improvement? ❑Yes ❑No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
eleyation markings? ❑Yes ❑No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes ❑No
11. Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Yes ❑No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑Yes ❑No
14. a)Does the facility lack adequate acreage for land application? ❑Yes ❑No
b)Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes ❑No
16. Is there a lack of adequate waste application equipment? ❑Yes ❑No
Reuuired Records&Documents
17, Fail to have Certificate of Coverage&General Permit readily available? ❑Yes ❑No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes ❑No
19. Does record keeping need improvement?(ie/irrigation, freeboard,waste analysis&soil sample reports) ❑Yes ❑No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ❑No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application) ❑Yes ❑No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes ®No
24. Does facility require a follow-up visit by same agency? ❑Yes ❑No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ❑No
0:NO violations or ilelicier�cies were notes d�rtng this;visit:•Yoti will-keeeiye iiq further' '.-'..-
corres on nce.abouk this visit.•. .
Comments(refer to question#):_Ezplam auy YES answer`s and/oi`any recommendations or any other comments.
Use;drawings of facihtyto bet#er;expWn situations {ttse additional_page-s as necessary)
1. tvgs+c is
Ieek;e\ frog A �IQ9 Itio&tSe . bwr)e^r neeQs �d -
e_&q&. f ert�ta,rley�� SoJU�►an +� s`��� [eqk a►�� �revevl� �'v�-�'L�er
a(;-s c ka�
-r�ee-< �eed -�-a be -emOVed �'ra lagaoh d►'ke war f�s dw
$G)ez ,W 6av14,5,,z,4 Nt2GS Aov' -r'Or6 ✓ re►'t-tvvetj Fr`edure5 .
'], �Di ke LvA l hr sLtoccfOt 6� G 1 ee'"A a-r/' crJeedS a'� woodsy veJca-�c ;o+�
Qhd �ra�ocr 9 amass Vec�e�-Gr�'iav� S�o�cld �� es-{-a�1; S1�ec�.I
c�
Reviewer/Inspector Name =54
Reviewer/Inspector Signature: Date: 7 ZZ R
3/23/99

[3.Division of Soil an&Water Conservat<on -Qperation Review
°C]Division of Soil and•Water Conservation--.�ConapGance Inspection
Division of Water Quality C?niphance Iaspecfaan
n
Other A enc O erahon Review „ _ z �
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-tip of DSWC review 0 Other
Facility Number Date of Inspection a `j
Time of Inspection ®24 hr. (hh:mm)
Permitted © Certified ©ZCd,,'t,*,nally Certified © Registered E3 Not O erational Date Last Operated:p ..........................
Farm N. ..... ...: ................................... .. Caunty: ....D}•.f.l't1.
Owner Name: ........................................... .... Phone No:
Facility Contact: ..............................................................................Title: ................. Phone No:
MailingAddress: ..................................................................................................................... .......--.................................. ---Y............................... ...-.......-..............
OnsiteRepresentative: ... , . ........................................................................... Integrator:...:... .......... .............................................
f
Certified Operator:................................................... ............................................................. Operator Certification Number:..........................................
leqcat'ppofF rn
....... .. . 1 -------�'S/...-. . .........,...,.,-,.,,-,....---k-...,--....:.......................-..-.. .. 9.... .... .. ..........................A .. q---....,
f + y
... �.!'�....\. ..... .........A..•1. •`•••I......................................................................................................................................................................................_...... T
Latitude ���� �•� Longitude
Design Current Design T Current_ Design Current
Swine = Capacity Po ulatiori wp6ii ry: Ci acity..Population,. Cattle Capacity Population,
Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish ❑Non-Layer vy: ❑Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design,Capacity ^
❑Gilts - s
❑Boars = Total-SSLW
Number of:Lagoons ,. ®= ❑Subsurface Drains Present Ego.. ❑Spray Fiel
d Area '
Holdtng:Ponds/Solid Traps �, _ ❑No Liquid Waste Management System
Discharges&Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes , No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance than-made'? ❑Yes ❑No
h. 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 systeEn?(If yes, notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes JN�No
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): a .
! 3 ...... ................................... ...................................
....................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/trees,severe erosion, ❑Yes XNo
seepage, etc-)
3/23/99 Continued on back

c.,r Facility Number: — 3,C$ Date of Inspection
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes C '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? D(Yes ❑No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? [:] Yes [kNo
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes [R'No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes N No
11. Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑ Yes D(No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑ Yes MNo
14. a)Does the facility lack adequate acreage for land application? ❑Yes r--'No
b) Does the facility need a wettable acre determination? CKYes ❑No
c)This facility is pended for a wettable acre determination? ❑ Yes N'No
15. Does the receiving crop need improvement? ❑Yes D?rNo
16. Is there a lack of adequate waste application equipment? ❑Yes j4No
Required Records& Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes [A 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 No
19. Does record keeping need improvement?(ie/irrigation, freeboard, waste analysis&soil sample reports) Yes ❑No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes gNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes N No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems, over application) ❑Yes �No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes F No
24. Does facility require a follow-up visit by same agency? ❑Yes 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes No
0:�'Vo yiolai>ttjris:or deftcier�cies mere potea dWi tg-(his*visit.' Y:oix;Willi eb.iye dd futtMe
Torres oritieirce:ahbiif this:visit:•• : : : : : : :
Chin hints(refer°to•question#) -.Explain any'YES answers and/or any re cotnmendaitons oin_ay other comments r
Llse drawings of facility tabetter:explatt sttuatiotis {use additional pages asnecessary} 3- ,
.A.
t q'c­7 4? 1ha �
►-ems Cam +- sus t-
l r=
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
3/23/99

,a Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below x'es ❑No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [YNo
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 O<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 9No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Ayes ❑No
Additional.Comments and/orDrawings:.`
-e 1:::�Q �
ti
3/23/99

r ❑Division of Soil and Water Conservation ❑Other Agency
Division of Water Quality < =
O Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Other
Date of.Inspection
Facility Number
Time of litspection GO 24 hr.(hh:inm)
Registered D Certified ©Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated:
1
Farm Name: .G... t'''� County:.............. . .. L.!1.......................... .......................
Owner Name. 0 � .. ........ . Phone No. ...................................................................
Facility Contact: ..............................................................................Title:..................... Phone No:
Mailing Address: 935C.....t^w�..... �.`r>..��5t.�... .......S}4... l�`.`..:.�1��!� �.�......d-V.��S......................
Onsite Representative: !^p` .1 4,...1' b��. !`.e +.. ............... Integrator:..... y, ...................................................
.........................
Certified Operator................................................... ............................................................. Operator Certification Number:............................_......
......
Locatio f Farm
�`^........ �- ..... .............I............`............. �-1..�,... . -----.... ��X�.......... .!�1.... ....!^�.......... .
. 1,,G.. .................. .............................................................. •
Latitude Longitude
N, >Desi- Current Design 'Current" Design Cucreiit ,
vS iney -$Capacity,`Ptjpulahon 3 Poultry ry,Capacity 'Populatton- Caftle Capacity Population_
❑Wean to Feeder ❑Layer JEI Dairy
❑Feeder to Finish
❑Non-Layer ❑Non-Dairy
❑Farrow to Wean
`r� ❑❑ Other Farrow to Feeder
❑Farrow to Finish TOfI DeSlgtl Capacity
❑Gilts ' y
❑Boars i ^� �` _�'� �� ��'
Total SSLW
Number of Lagoons/Holding Ponds ® ❑Subsurface Drains Present ❑Lagoon Area Spray Field Area
u, ' WMIN
� <
m ❑No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑Yes ❑No
2. Is any discharge observed from any part of the operation? Yes ❑No
Discharge originated at: ❑Lagoon ❑Spray Field Other
a. If discharge is observed, was the conveyance man-made? L(Yes ❑No
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) ❑Yes EffNo
c. If discharge is observed,what is the estimated flow in gal/min?
d. Does discharge bypass a Iagoon system'?(if yes,notify DWQ) 'Yes ❑No
3. Is there evidence of past discharge from any part of the operation? ❑Yes ❑No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes ❑No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ((Yes ❑No
mai nten ancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ❑No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes ❑No
7/25/97

Facility Number:'3 t — �
i..
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes ❑No
Structures(Lagoons,Holding Ponds,Flush Pits,etc.)
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes ❑No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
................................... ................................... .................................... ................................... ................................... ...................................
Freeboard(h): .................................... ..........
.......................... ................................... .................................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑Yes ❑No
11. Is erosion,or any other threats to the integrity of any of the structures observed? ❑Yes ❑No
12. Do any of the structures need maintenancetimprovement? ❑Yes ❑No
(If any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
13, Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes ❑No
Waste Application
14. Is there physical evidence of over application? ❑Yes ❑No
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
15. Crop type ............................................................................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes ❑No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes ❑No
18. Does the receiving crop need improvement? ❑Yes ❑No
19, Is there a lack of available waste application equipment? ❑Yes ❑No
20. Does facility require a follow-up visit by same agency? ❑Yes ❑No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes ❑No
22. Does record keeping need improvement? # ❑Yes ❑No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes ❑No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ❑No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑Yes ❑No
[]-No.violatiois-or deficiencies.wwere-noted-during thisMsit.-Y_ ou4ill recei've-_i�o-furih:ei~:
eoeresp9ndehce aboht-this.visit::•:-
mm� �
�Gi r fer to gt o��Exp a►ti arey Y aas emirs aor�any reenmmendations�or any other comtnefts
raxvttgs of tadhtysfrt better explam:s�tuattpns.( additional gages asecessary)fFA
fiL_ tt�,� ���-, �. ►d�
Ir��l►'3 c�� � h--�-�s2. ��-..Q.� Cam•-��I� s c-�►�c U�e c�,
7125/97
Reviewer/Inspector NameFw „' �5ti , !- ��` rr.A
Reviewer/Inspector Signature: Date: fy
L ��

x 13 Division of Soil and Water Conservation ❑Other Agency
� ]Division of Water Quality
Routine O Complaint O Follow-u "of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection I ZG
Facility Number
Time of Inspection _q<o� 24 hr.(hh:mm)
Registered Certified ©Applied for Permit © Permitted 0 Not Operational Date Last Operated:
Farm Name: ............ .0......l�Y:f:iJj........ ..........1A. County: ..................... . .......................
Owner Name:....................... ............... Phone No: Q�. .- .......................................
Facility Contact: .............................................................. .......Title: Phone No:
Mailing Address: ...Z G........ ir.1.A.......Cf asa.. ......U.I.............. ........�.NA.A.:a.f.ill.e j.....N.� .................................
Onsite Representative.:............&Y.6......&Y.�1�1�...... .. Integrator:....Mt1► ..................................... ....-----
1�
Certified Operator;.................................................. .............................................................. Operator Certification Number:...................
Lmation of Farm:
.Or`... .4........ +.e...:..b. ....e: ,.[b ....f... ?.:.?-�—.rns:...........c...0:r. ...... (.304............I................ .... i
........................... ......----.... . ....................... .
Latitude � •. '��� Longitude
:. r ;"3Design ' Current' Design '' .Current Destgp . ` Current
-a acit Po �ulation 'Cattle Ca acE Po ulatioa
wtne � xCapacity Population Poultry P Y� P P h' ; P
❑Wean to Feeder ❑Layer 10 Dairy
Feeder to Finish ❑Non-Layer ❑Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity,
❑Gilts
❑Boars Total.SSLW
Number�of Lagoons[Holding Ponds © ❑Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
❑No Liquid Waste Management System
General
L Are there any buffers that need maintenance/improvement? ❑Yes EM No
2. Is any discharge observed from any part of the operation? ❑Yes C9 No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑Yes Lb No
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) ❑Yes N No
c. If discharge is observed,what'is the estimated flow in aaYmin?
d. Does discharge bypass a lagoon system'?(If yes,notify DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ❑Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes to No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes 9No'
niai ntenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in' effect at the time of design? ❑Yes �LNo
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes No
7125/97 Continued on back

Fac5ity\umb`c•r: 31 -- 3
8. Are there lagoons or storage ponds on site which need to be properly closed'? ElYes No
Structures(La goons.11ol dine fonds,Flush Pits,etc.)
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes ($r No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �............... . z
Freeboard(ft) .............. .......... ...........�...�... Z.M - ...... ...................... ................................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑Yes UNo
11. Is erosion,or any other threats to the integrity of any of the structures observed? - ❑Yes 9 No
12. Do any of the structures need maintenance/improvement? ( Yes ❑ No
(If any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes 0 No
Waste Application
14, Is there physical evidence of over application? ❑Yes 53 No
(If in excess of WMPI,or runoff entering waters of the State.notify DWQ)
15. Crop type ..................�?.ex n! 4.-........................SP.:' ll....Or1.t i:4............................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)'? ❑Yes JK No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes No
18. Does the receiving crop need improvement? Yes ❑No
19. Is there a lack of available waste application equipment? ❑Yes No
20. Does facility require a follow-up visit by same agency? ❑Yes No
21. Did ReviewerAnspector fail to discuss review/inspection with on-site representative? Cl Yes No
22. Does record keeping need improvement? Yes ❑No
For Certified or Permitted FacilifieSQDIX
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes 9�No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes [ No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑Yes No
0 No violations or deficienCie's.were-noted during this:visit.- Yoit.will receive no ftirtlier
correspondence about thisvisit'.-
Coitdunents(refer to question# : Explain any Y`E5'answers and/or any recorninendatrons,or any other,commetits 'ga '
Use`drawings of factiity to better e`xpI iti situations (rise adds;ional`pages ds`necessiirv} X� k
V. _ .
D �9 f I1 1 . IF
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I+�U rnl��'• 7/25/97
Reviewer/Ins ector\ame s N
Reviewer/Inspector Signature:_ jt, �` Date: 2-

.w l- -,
0 DSWC An><mal`rFeedlot Operation Review y �
DWQ�An>mal Feedlot Operation Site Inspection
.x.
g Routine O Complaint Q Follow-up of DW2 inspection Q Follow-u of DSWC review Q Other
Date of Inspection I Ig u
Facility Number Time of Inspection 24 hr.(hh:mm)
Total Time (in fraction of hours
Farm;Status- Registered ❑Applied for Permit (ex:1?5 for I hr 15 min))Spent on Review
❑Certified ❑Permitted or Inspection includes travel andprocessing)
❑Not Operational Date Last Operated: ...... ..... ..... _............................ .. . ............ .... . ......_......
Farm Name: . -ol-A....... '.[? i--P...S .. . r.r'"'` County:. ..�..s..n. ... t �..�
Land Owner Name: ._.�$ .s�.. .... ... �►..�.t.!_.C� .�..-�....�..... Phone No: .... ...w-5�..� �............
Facility Conctact:......_...._.... .. .... . .. .... .... Title: Phone No:
Mailing Address: ...Z_, ....� .�!?^ ..!�. .�.!`^.._.�..1t s�..i.i!'° ...�.t�.�.... .� Q. .s..11�...N L.... .Z..g..Zt.5
Onsite Representative: ...E.Q.. ,.. er 1r l .�,t egra •............� Int tor.... ._................._..................:.
Certified Operator: ..._ Q _. .P.r4. ........................................... Operator Certification Number: ?:.. 6. .....
Location of Farm:
�...�n.s.#.......s.i. e......o. --... . ._L.i�.�2.i}..T......��..�..r:a.��.,r.�s..s� .. .......II.x....l........�r.�a,.x �.,.�......�.�.��:L�.......a........rr� . . Q
Latitude Longitude �• �� ��
Type of Operation and Design Capacity
: 'F _t
g Ctrnt Ai; C attlee
C Wilke, a ac eb PhlaEonlatin a Aes�gn 1°oCC on" � Itry rr)r&a
ehnoE
ii
El '"Wean to Feeder ❑La er ❑Da'
Feeder to Finish t7 C) ❑Non-La er r[fNo
n-Da
Farrow to WeanME
IV
Farrow to Feeder FWL
5. Total Design Capaetty 4 o0
El Farrow to Finish
1
EJ Other
.Total SSLW a7sd
�,� Number of La000s.!HoldingPorids z ❑Subsurface Drains Present -
a -
� ray F
❑Lagoon Area � ❑Sp field Area
General
1. Are there any buffers that need maintenance/improvement? ❑Yes ®No
2. Is any discharge observed from any part of the operation? ❑Yes O No
Discharge originated at: ❑Lagoon ❑Spray field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ®No
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) ❑Yes ELNo
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 IS-No
3. Is there evidence of past discharge from any part of the operation? ❑Yes ®No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes ja No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes E(No
maintenance/improvement?
4/3Q/97 Continued on back

Facility Number: 7 j.......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes IR No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes J9 No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes ®No
Structures Lagoons and/or Holding Ponds)
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes ®No
Freeboard(ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑Yes ®No
11. Is erosion,or any other threats to the integrity of any of the structures observed? ®Yes ❑No
12. Do any of the structures need maintenance/improvement? Yes ❑No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat,notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes RLNo
Waste Application
14. is there physical evidence of over application? ❑Yes O No
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
15. Crop type x �✓Y1:L1.41 .,ra a \ ..... ....... . .�i 1C r r t.c�C� ..... V _ ---,...........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes a No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes ®No
18. Does the receiving crop need improvement? Z Yes ❑No
19. Is there a lack of available waste application equipment? ❑Yes allo
20. Does facility require a follow-up visit by same agency? ❑Yes 0 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes ®No
ILCertified-Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ®Yes ❑No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ®No
24. Does record keeping need improvement? ®Yes ❑No
Comments(refer to ijuest;oa`#) Explain any YES°answers`and/oi.any recommendat�ons'or any other comments
Use drawings of facility to better zplainsitiiatians :(use additional-pages as necessary) ��. w �
.�.-t--app.�,�+.�
i i a t a r N t-CIS n{r LA �r-
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Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
cc.- Division of Water Quality, Water Quality Section, Facility Assessment Onit 4/30/97

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL.FEEDLOT OPERATIONS SITE VISITATION RECORD
• DATE: a�' , 1995
Time: 3 ¢
Farm Name/Owner: 60cs 15 -hr e lGI
Mailing Address: Z 3 a m e; [i'r?S Cry SS ra 5 1'1 . ���5L Z 33(n S
County: ou io
Integrator Phone: 675 3�- 310q
On Site Representative: /Vc4 e- Phone:
Physical Address/Location: K Vint- Q63 sU t� coo SYC Ia04, - .�h-a' =,1.4 Mi
1n
Type of Operation: Swine i,-' Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: - ' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot +25 year 24 hour storm evens
(approximately 1 Foot+7 inches) Yes or No Actual Freeboard. "-7Ft_ Inches
Was any seepage observed from the lagoon(s). Yes r No Was any erosion observed? Yes o DO
• Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No Z
Crop(s) being utilized: 2
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Vo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No ?
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o C90 If Yes, Please Explain_
s:
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: W 2SAQ_ -0 2 h0 U 5e. .i-5 hQ p25 S r 4
T—�'
604 C 0-e
5t
O Z G" e , Wr �) be C i e4 $ 5 b Ock, n
�U0 5c. Wei 6 RL f- E m 5: Ca r1ecfa4
2� Q Sfer-b e 2 H Ur p h q bovi fie roblei n _ wJ
A_pL . probfein Ke��WVed.
• Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATION BRHNCH - WO Fax:[phone] u 1 13 '95 y:17 P. 10 r 17
0 /1`''95 18:0s V9102062122 NRCS Lo1)1':
Site Rc-quixu-s Immediate. Attc:,6)n
Facihtv Number:
S11'E W1S1'Z'A'f10',RFCOtZD
DATE. '/ 7/ ,
995
owner: .farm Namt-:
4Qi7IlEy; �ZL
N .,___
. ent Visiting Site: ILI 4 —ry
Fhnue:
Operator: _ _ _ _ _ _—_ Phone:
tin Site Representative: �—� pholic;
Physical Address:4 _ - - - ►�,c /� s _- _( r�rt..J �
[Mailing Address:
Type of Operation: Swinc Poultry Cattle - - ------ - -----
Desi,gn Capawry: Number of Animals on Site:
Latitude:
Type of Inspection: Gratund Aerial
Circle Yes m No
Does the Animal Waste,LaQovn have sutdcient freeboard of I Foot -25 year 24 hour storm.event
(approximately I Foot+7 inches) Yes o N Actwd Freeboard: —._•,-Feet __•___Inches
For faeitities_with more than one lagoon, phase address the other lagoons' freeboard ruder the
co.rl'sTncnrz
Was any seepage observed #Tort#the la,=oon(s)? Yes or �o WV is there ez-osion of the darn?' Yes or No
Is adequate 1xid available for land application? Yes or No Is thel cover crop adequate? YCS or No
Additional, Comments: 1 ,,t
Fax to [phone] Signature of A8tnt

Site Requires Immediate Attention:
Facility No. Q
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 10 '3 , 1995 p ,(.
• Tirane: ��� i� Pal(1 vect
Farm Name/Owner: h e �a
Mailing Address:
County: _ Duo I i n _
Integrator: MUrphA.- Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Number of Animals on Site: _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot +25 year 24 hour storm event
(approximately 1 Foot+7 inches) Actual Freeboard: 3 Ft. �Inches Yes or No
Was any seepage observed from the lagoon(s)? Yes o No as any erosion observed? Yes No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility rueet SCS minimum setback criteria? 200 Feet from Dwe?linas? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste Iand applied or spray irrigated within 25 Feet of a USGS Man Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facilitv maintain adequate waste management records (volumes of manure, land applied.
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: _
5e*1 K eA" c-ro5S. 5freet
i b e l z►,It V er m illo r -- no
Ch W Sv4- 4P_ w zfPrs.
_ C L ewr.5 _
Inspecior Name Signature
cc: Facility Assessment Unit Use attachments if Needed.