310404_INSPECTIONS_20171231

NORTH CAROLINA
r�
Department of Environmental Quai

Type of Visit: aD Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: L D Departure Time: County:
Farm Name: m t u��rr. Owner Email:
Phone: 9 l 0 9 3 y os r j
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �{� rve
Certified Operator:
Title:
Phone:
Integrator:_
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Design Current
Capacity Pap.
Finish
1 !40 7FEeder
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dai Cow
DairyCalf
Feeder
Non -La er
o Finish
?.Q(
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
D t P,oult , Ca 8ci P,o ,
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
I Other
113eef Brood Cow
Qther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes WNo DNA ❑NE
❑ Yes
❑ No
[,g NA
❑ NE
❑ Yes
❑ No
S] NA
❑ NE
❑ Yes
❑ No
EP NA
❑ NE
❑ Yes
[f] No
❑ NA
❑ NE
❑ Yes
[x] No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Faci[i Number: Date of Inspection: f Z 215-1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
f=
waste management or closure plan? '
No ❑NA ❑NE
❑ No NA ❑ NE
Structure 6
❑ Yes W No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Q9 Yes []No ❑ NA ❑ NE
S. 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) 'y
9. Does any part of the waste management system other than the waste structures require ❑ Yes E; No ❑ NA ❑ NE
maintenance or improvement? p ' T
Waste ADDheation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
['V1No
❑ NA
❑ NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
J[p 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): b 1- [
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[5No
❑ 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
[50No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
TT
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[A No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[P 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. 0 Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ® Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EA No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA [A NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of inspection:
24-Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes fia 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA `-�] NE
❑ Yes Qa No ❑ NA ❑ NE
❑ Yes © No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes Ea No
❑ Yes [$ No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).:
4?A
_AA1 'O�VAVT
C&k 1� A-
W4
f
"lb;\ I ' -1l �lb
Reviewer/Inspector Name: ��'4 e YV e-
Reviewer/Inspector Signature:_
Page 3 of 3
14C C;brw of (a1' ^ P4S
Phone: %) tovI
Date: t 2411
214 01 S

Type of Visit: 40 Com a Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 5 Q Departure Time: © County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Region:
Certification Number: (7 Zj L
Certification Number:
Longitude:
Design %-_U IFJX 1111
Swine Capacity Pop.
Wean to Finish
Wet Poultry Capacity Pop.
Cattle
DairyCow
DairyCalf
Dairy Heifer
it
Capacity Pap.
W an to Feeder
HLayer
Non -Layer
Feeder to Finish
Farrow to Wean
-to4is
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
Dr. P,quttry Ca act P,o
Layers
Non-Dai
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Qtber
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes �o
❑ Yes E�No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Page I of 3
21412015 Continued

IFacility Ntlmber: 7ifp Date of Inspection: 9 2i
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
Ej oo
❑ 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
To
❑ 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 5'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 i No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZeNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes � ❑ NA ❑ NE
❑ YesrNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes [2No ❑ NA ❑ NE
❑ Yes En -No ❑ NA ❑ NE
[] Yes Vf No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 21412015 Continued

Facie .Number: 3 - ;{O 113ate of inspection: 10 -s /"4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ej­No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [2-Ma- ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No CNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
En —No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
G�J'No
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
TT
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑'1Go
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
f;�No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Comments (refer, to question #): Explain any YES answers asidlor any, additional, re+ ommendations or any, other comments.,
Use drawings .of facility to:better' explain situations (use additional'pages as necessary).
�r—Ire Co/ j 3 ( .s � 9Po C
r- v,, A- -
"(,a re le�_-
('CfLffS
r � rr-c1 E 3
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
[moo r frSLr'f q..Cj fa-,cj
S Or I jP S -�- rYC Q_L_IJ
Phone: i 716 73—�-
Date:
21412015

(Type of Visit: O'Com nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
ou Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
.41
Date of Visit: Z 3 Arrival Time: Departure Time: �Q— I County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: (� f jTitle:
�},
Onsite Representative: t ' ` 0AA �C Integrator:
Certification Number:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design
Swine Capacity
Current
Pop.
Design
Wet Poultry Capacity
Current Design Current
Pop. Cattle Capacity Pop.
iry Cow
Wean to Finish
�Ynn to Feeder
Non -La er
iry Calf
ceder to Finish
Farrow to Wean
,?/j
Design
Current
i Heifer
DEXCow
Farrow to Feeder
Farrow to Finish
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
UOther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E5 No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes rl"No ❑ NA ❑ NE
Page I of 3 21412015 Continued

[Facility Number: - Q jDate of Inspection: 2ZZT
V
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
ffNo ❑ 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
[" o ❑ 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
ONo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E!3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ffNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZfNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes VNo
- ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fNo ❑ 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 No ❑ NA [] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available? Yes ❑rNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes eNo ❑ 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 rNo
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

neil�mber: jDate of Inspection: 23
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El"No,.
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ YesEl-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
Ej No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[] No
ErNA
❑ 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?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes EfNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 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 0 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 E�<Nco ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No, ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #):;Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as.necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/r 10 4 A
r I P irl/r/
U ✓ 1 C (,,,--A
Phone: { 10 7P 7301
i
Date:
214120151t

. 11 ..
Fcility; Nurriber
Itsion of Water�Qa(ity
Q Divisioiiof,5oil and'FWater.Conse
0"ether AQenev... � ��
Type of Visit�npliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit,(>Routine O Complaint O Follow up 0 Referral O Emergency O Other % ❑ Denied Access
Date of Visit: Arrival ime: Departure Time: C] County: �� [ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: % Title: Phone No:
Onsite Representative: :.P Integrator:
air
Certified Operator: Operator Certification Number/7
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= O = 6 Longitude: C
O = 1 = Lf
Designer CurrentN�A'; �"DesignPrCurrent Design Current
Swme�r'. r Capacity Population " wWetaP.oultryCapacttyPoulatrooC$le Capacity- Population
❑ Wean to Finish
ID Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
El Feeder to Finish-
- .-�
�` w El Dai Heifer
❑ Farrow to Wean
d El Dry Cow
El Farrow to Feeder
Dry Poultry. ."
_ � �.�w �: El Non -Dairy
` ❑ Farrow to Finish
Layers
El Beef Stocker
❑ Gilts
ElBeef Feeder
El Boars
❑ Beef Brood Co
Turke s
Turkey
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes XfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
;� No
❑ Yes P No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
12/28/04 Continued

FacilityNumber: - Date of Inspection:
Wastegollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ; rio ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;ET 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 ;D'No 0 NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes .0 No ❑ NA 0 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) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes e PTNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes pa"No ❑ NA ❑ NE
maintenance or improvement? pa
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et ?""
❑ 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 P'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ff No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes pr'Ro ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;a"No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
; io
❑ 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
:)4o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
T
❑ 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
O No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ection: 7
24. Did.„&he facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 71 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZrNo ❑ 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 ONo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Z—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 O 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 4!fNo ❑ 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 CAW1vIP? ❑ Yes ;allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes [7"No ❑ NA ❑ NE
9
Reviewer/Inspector Signature: ' Date: 1 �17
Page 3 of 3 21412011

Type of Visit .EY'Compliance Inspection O Operation Review O Structure Evaluation
Reason for Visit-94outine O Complaint O Follow up O Referral O Emergency
Date of Visit: rival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
O Technical Assistance
O Other ❑ Denied Access
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = e 0 d = Longitude: = ° = , 0
Design Current
Swine Capacity Population
Wet Poultry
❑ Laver
Design Current
Capacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Dairy Cow
❑ Wean to Feeder
on -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
- ❑Turke s
❑Turke Poults
❑Other
❑ Dairy Heifer
El Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
10 Beef Brood Co
Number of Structures:
Other
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
r No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ I A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 3 — dt. Date of inspection d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Vf No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PdNo ❑ 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 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes [� No [I NA [I NE
through a waste management or closure plan? r
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V
No El NA ❑ NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. -Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ElNA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #) 'Explain any YES answers and/or anyrecommendations or"any other comments
Use drawings.of'facility "to'better:explaen situations. (use:add'etianai`pageimi s•necessary}
Reviewer/Inspector Name /' Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number:y & G Date of Inspection ,
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ICJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZFNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes .Z No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;;rNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
[]Yes
F!fNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[,_j'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ 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
�TNo
❑ 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
VNo
❑ 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
allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
?(No
❑ NA
❑ NE
Additional Comments and/or Drawings: "
Xf
f�l l
Page 3 of 3 12128104

Type of Visit S
Reason for Visit
Date of Visit: U%/
Farm Name:: __7
Owner Name:.
Mailing Address:
Physical Address:
pliance Inspection
)utine 0 Complaint
Arrival Time: 1 W
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
QG parture Time: County: Region:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator: / v(
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 6 = . =di Longitude: = ° = 6 = it
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
i
DesignFurra
entWet Poultry Capacityu l
a ❑Layeion
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Puliets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ DaiEy Heifer
❑ D Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0] No
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
i
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 XNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J2'&o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �No
El 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 ONo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes JZNo
❑ 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 OQ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes ,L30Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ;2No
❑ NA
❑ NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes ,21'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
/_
❑ Yes JVNo
❑ NA
❑ NE
Comments (refe�r,�t�a,quesh�oMn #) ,�plamany�YE�S�answ�eis� a�, n or��n�y�ommendations ar any other comments.
Use drawtngs�of factLty to betteraexplam sttuat�ons`�(useyadd�it►onalipages4as`��ecessary� - -
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 I2/28104 Continued

Facility Number: Date of Inspection
Required Records & Documents
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 2f No ❑ NA ❑ NE
the appropirate box. ❑ W­UP ❑ Checklists ❑ Design El Maps ❑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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,ZNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
Z
[INA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4!�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[To
El
El 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
❑,IQo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
//
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑,No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;IN.
❑ NA
❑ NE
Comments and/or
'0-Va r /. -5:.-
2-3
12128104

IType of Visit �Kompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visi�Routine Q Complaint Q Follow up O Referral O Emergency Q Other [I Denied Access
Date of Visit: Arrival Time: i� �� Departure Time: County:
Farm Name: - Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: //,�, _�Phon No:
Onsite Representative: Integrator: /ri
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: [= o [= 4 [� 61 Longitude: = o = 6 = it
Design Current
Current Design C►urrent
Capacity Population
Wet Poul"Design
apacity Population Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
7Feeder
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Finish
❑ Laer
Feeder
❑Non-Laer
Finish
oult❑❑
FEILayers
❑Non -La Non -Layers
Farrow to Wean
Farrow to FeederFarrow to Finish
11[]
❑ Gilts
Boars
El Pullets
❑ Turkeys
❑ Turkey Foults
Other
❑ Other
❑Other
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
�No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[3 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)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
❑ NA
❑ NE
jo'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
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 XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes 6No El NA [I 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 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA El NE
maintenance/improvement? !!
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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
J'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
<0
❑ NA
❑ NE
Comments (referrto question #) :Explain any YES_answersandlor�aoy recommendationsnr any other comments.
�Use'drawtngs=uf facaliity to better�ex lam sttuatEons�(use additional pages as�rRecessa
Reviewer/Inspector Name Phone: O�
Reviewer/Inspector Signature: Date: f =(---P
Pnvv 2 of 1 12/28/ 4 Continued

Facility Number: Date of Inspection
!R'e_quired Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [2"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes FjNo ❑ NA ❑ NE
the appropirate box. 0 WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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
,� No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E`No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
INo
❑ 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
PNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
F'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments ,ani d/Qr,Draw1IIg5_$,.. �, �' � .. Y �, � .��s :•� ix �" Vic`^ �$ �7 .,
n
Page 3 of 3 12128104

'Division of Water Quality
Fa �ility Number i �4y O Division of Soil and Water Conservation=
_- O-"47 Other Agency
Type of Visit oCompliance 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: T TT Arrival Time: .' Departure Time: County: Region:
Farm Name: i'i^ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow, to. Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: n c n' n« Longitude: n 0�n' n
Design Current Design Current
Capacity. Population Wet Poultry Capacity Population
❑ La er k
I❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts Y,
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current'
Cattle Capacity Population
❑
Daip, Cow
❑
Dgg Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
l
91
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — rJ Date of Inspection 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
identifier: %
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 12�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �3 No ❑ NA ❑ NE
❑ Yes '[i] No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [:]*No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes allo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O AV o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
12No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
gNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P'No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name yA'4141— Phone:
Reviewer/Inspector Signature: Date: 3' 6 ri
12/28/04 Continued

Facility Number: -?/ GG Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes- PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes jNo ❑ NA ❑ NE
El Checklists Design ❑Maps ❑Other
the appropriate box. ❑ WUp Checklists L
21. Does record keeping need improvement? If yes, check the appropriate box below.
1211es
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis _ ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E *No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;}No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Rvo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Po
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
L21NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ONo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
F�
❑
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
-ETNo
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑,No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�13/e� ?
�� .S/� h �� aK � o -� r.✓1�� w ral ���
w�s� �•��js/s f
y -1 .�� uf�✓'
y
I Z/Z8/04

1�
Type of Visit_,.eSCompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ICJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:�.J/b/�Gf/�f���
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
C Departure Time: County:
Facility Contact: Title:
Onsite Representative: A'�'4
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: =c [= 4 =,S Longitude: ❑ ° =, ❑ «
Design
Swine Capacity
Current
Population We# PoultnS'
Design
Capacity
C►urgent Design
Population C►attle Capacity
C►urgent
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑Dai Calf
Feeder to Finish �OOO
Dry Poultry
❑Dai Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Layers
❑ Non -Layers
❑ Boars
❑ Pullets
El Turkeys
❑ Turkey Poults
❑ Other
Other
Eliot er
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes Z 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
El NA
[I NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
,❑
b NNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LJ E�lo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

FacilityNumber:3 1 — i, Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M. ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes .0 No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes L '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 J2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;�]'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �LNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes El -No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
n Ontgide of Accentnhle C mn Windnw n Evidence of Wind Drift n Annlicatinn 0iit,6de. of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
610�4o
❑ NA
❑ NE
l5. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
� o
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations.or any.other c.o.mments -:,..,''-
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerAnspector Name y Phone: D —
Reviewer/Inspector Signature: i Date: 6 0
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection .�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,Q'No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 ff No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
4NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
.❑ No
ONA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
,ZINA
❑ 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
ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C3No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2'1`Io
❑ 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
ZNo
❑ 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
O No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JR No
❑ NA
❑ NE
Additional Comments and/or Drawings:
r G�r�� 1'!� v, p 1-,6
1:�rljj rs �� �'o �s�� y
Page 3 of 3 12128104

Time:
OP—erEnitted 13 C nditionally Ce ed. 0 eRegistered Date Last Operated or Above Threshold:
Farm Name:. ___ _ .__ . - County:
Owner Name: __.__ _....._.... .W........_ . .._....__..__...._ _ _ __.... Phone No:
Mailing Address: ...........
Facility Contact: ............
../_�....., ._._ .. ....... ------------ Title:.. ....—------ _ _ �f Phone No:
Onsite Representative:.- Integrator: -!! U r
Certified Operator: _. .._.._........... _._ _ _._ ............ Operator Certification
Location of Farm:
grswine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` " Longitude • 4 «
�; Design Current Design, Current DesignCnrrt'
Swine �, , Ca Vacs PoWiilalian, 4 PoWtry _ y. _
Po `Mahon
CaWe�Ca ciPo. hon�
Wean to Feeder ❑ Layer €-_ Dairy
eeder to Finish Q i W Non -Layer ❑Non -Dairy
Farrow to Wean _ , .m �. _ r
�� x
sr F id
r
Farrow to Feeder Other _
r.- .a. -�; _r s z -
Farrow to Finish = z
�1 - Toil Des>�gn Capacityg
Gilts r g
Boars; '£- To> s1jSSLW
E
m Numberrof,LagOonS "r -
x
7�.. Y c
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes .2 0
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 .Q iTo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes $llo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes .0090
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:........... ........ ..... I.... ................. ....... .... .............................. ...... _. -- - ........_.. ..... ........... _...........
Freeboard (inches):
12112103 Continued

17o oy
Facility NumberL2 Date Inspection
of
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
INO
❑ Yes
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 0 N' o
8. Does any part of the waste management system other than waste structures require maintenance./improvement?
❑ Yes ;�"No
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes RrNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes P40
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops dmifer with those designated in the Certified Anim Waste Management Plan (CAWMP)?
❑ Yes jErNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 2140
b) Does the facility need a wettable acre determination?
❑ Yes E3No
c) This facility is pended for a wettable acre determination?
❑ Yes )2No
15. Does the receiving crop need improvement?
❑ Yes Ro
16. Is there a lack of adequate waste application equipment?
❑ Yes �vo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
,
❑ [_I Yes eNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ZrNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes J2'lgo
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 OIL
Air Quality representative immediately.

Facility Number: r7
Date of Inspection
gequir d Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard pr<Vaste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
,�Yes ❑ No
❑ Yes ,Oto
VYes ❑ No
❑ Yes �lo
❑ Yes 01�o
❑ Yes d"'
❑ Yes 2rNo
❑ Yes S2'1q0
❑ Yes P'IQo
❑ Yes �o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_ ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditional`Comments and/or,Drawings A
v�3 �111,rll0 -3 z %l:S-' 05z 1��ff f 1 1 O
g1411 �SAS �fif
�
l s��
`57Q/0/ Aere
12112103

Date of Visit: �—..z-�--"ram =-�-+ Time: % /'�t
Facility Number
Not O erational 0 Below Threshold
® Permitted Certified 0 Conditionally Certified © Registered Date Last Operated or� Above Threshold:
Farm }Same: / County:
Owner Name:
Mailing Address:
Facility Contact: 'Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
yPyh�one No:
I ntegrator: /�/l�rJ
011
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' • D u Longitude 0' �' 0
Design Current
-.; Des►gn Current-Dcstgn Current
mSwRne Ga acttv:' Po nlahon
-; 'Pool.Cs actty
=Pa ulatiou—Cattle..,.:Ca araty. Pa ulaAon`
[] Wean to Feeder
r= ❑ La er
Dairy
.. ® Feeder to Finish
❑Non -La er
[] Non -Dairy
❑ Farrow to Wean
- -
❑ Farrow to Feeder
❑ Other I
I_.
❑ Farrow to Finish
Total Qe5ign CBpactty Y
10nJ
❑ Boars
-
Tt)tat`SSLW _
r Number of Lagoons ,
- ❑Subsurface Drains Present ❑ L oon Area ❑ 5 rav Field Area
_
Holding^Pands 7,Soltd Traps �� ❑ No Li uid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): Z !
05103101
❑ Yes eNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes - l No
❑ Yes El -No
❑ Yes O'No
Structure 6
Continued

Facility Number: — k 'k
Date of Inspection 27 3
5. Are there any immediate threats to the integrity of any of the structures observed?•(ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure'plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
9. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aonlication
❑ Yes I�No
❑ Yes �D No
❑ Yes ❑ No
❑ Yes No
❑ Yes �ZNo
10. Are there any buffers that need maintenance/improvement? ❑ Yes WNo
11. Is there evidence of over application? ❑ Excessive Ponding //❑ PAN ❑ Hydraulic Overload ❑ Yes ONo
12. Crop type 6z,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ErNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONo
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 ElNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 0 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ONo
18_ Does the facility fail to have all components of the Certified Animal Waste Management PIan 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 ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [Z 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
Im
HIL No violations or deficiencies were noted during this visit. You will receive no.further correspondence about this visit.
Commestts.(i efer to;quesii6n4 `E platy aay Yl? S answers and/or any recatutnendatioos or auv,other:iotnments : -
Iise: lrawtngs of'fx 7 v to'better explata� situations. -(use add€ttonal pages.as necessary) w ; i
s - ❑ Field Copv ❑ Final Notes
B✓C'��'s, ��s/wai� h�E� � �� ��k�7�i� �csfa 9�/G 5.��/4/r �'��K �� l
P�t1�'��° /L•
Li/k 5 flQfHw
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z /
05103101 f r Continued

Facility Dumber: 3% — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑Yes [�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 0 No
2& Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZNo
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 12 Rio
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 ZrNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes WNo
32- Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [ No
Additional Comments andlor.Drawings:
05103101

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number 3 Date of Visit: Z Time:
IQ Not O erational 0 Below Threshold
®Permitted ® Certified Q Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: ll/i /iP t/ ✓tiI County:1
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: .Sf�� /�I�/1f6iY
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: •���.
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 Du Longitude 9 6
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 91 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 El No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes F� No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Freeboard (inches): Z�
05103101 Continued

Facility Number: / — wly
Date of Inspection LZT4DL
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADnlication
❑ Yes 0 No
❑ Yes 0 No
❑ Yes [ No
❑ Yes FA No
❑ Yes E No
10. Are there any buffers that need maintenance/improvement? ❑ Yes R(No
11, Is there evidence of over application? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload ElYes' CZNo
12. Crop hype I" ��.t ZC r-A t !�h /ee J �h A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ElYes MNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes RNo
b) Does the facility need a wettable acre determination? ❑ Yes k,No
c) This facility is pended for a wettable acre determination? ❑ Yes 50 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 or other Permit readily available?
❑ Yes
EQ 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
to No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
W No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
®,NO
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[gNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[R No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�
�C ments(r` to.q honExplatn any Y«ESanswerandlorany recmmeii o"ns p any Tither om ents. ` ;At
,Use drawtngsof facdrty to better ezplarn s�ttiahons (use addrtronaL;pages as necessary) -. :a ❑ Field Copv ❑ Final Notes
s e x
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
O5103101 o Continued

Facility Number: Date of lirspec€ion 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 atlor below ❑ Yes ERNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes QNo
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [X1 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes (9No
5100

ti `. Div�sron of iWater Quality
_ I)iviston;of Soil and Water Conservation
11i Agency
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 ❑ Denied Access
Facility Number f Date of Visit:
13 Permitted © Certified [r Conditionally Certified ❑ Registered
Farm Name: ' C &e � � >� F c1
OwnerName: .....................i�............ ..................................................................................
FacilityContact:.............................................................................. Title: ..........................
WTime: ! 3Q Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .......................
County:... ..U�,� �. ...
MailingAddress: .................................. ............. ................................................. ..
Onsite Representative:....„ t l.�t.. .......... Ke '10 e a(...................................................................
CertifiedOperator; ........................ .......................... .............................................................
Location of Farm:
x swine ❑ poultry ❑Cattle ❑ Horse
Desigp ' Curr
Sri w C
'apadty Po ula
J.
lGilts
Feeder
Finish Z� U
o Wean
o Feeder
-To Finish
Phone No:
Phone No:
...........................f.....................1................................ ............... I..........
Integrator: ,!„•, ,`�,�r�,/...- i-c��'"'� r
.` I. ....... .....................................
Operator Certification Number:......... .................................
Latitude 0 & 44 Longitude • 4 66
Design Current Desr�n Current
t Poultry capacity Population Cattle 6liggidly To tion
❑ Layer ❑ Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other L
Total Design Capacity
Total SSLW
-' Subsurface Drains Present
Holding Ponds/ S61id Traps ° ❑ No Liquid Waste Manages
Dischar•ees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
Area Io Spray Field Area
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon systent? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier1........ . ..................................................................................................................................................
Freeboard (inches): Z S
5100
❑ Yes �INo
❑ Yes ONO
❑ Yes ,dNo
' /A
❑ Yes A No
❑ Yes No
❑ Yes )ZfNo
❑ Yes ,ffNo
Structure 6
Continued on back

Facility Number: 3I — O Date of Inspection �111310� � Printed on; 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ""No
._
seepage, etc.}
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes /EfNo
(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 3dNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes IffNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 0,140
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes )2rNo
12. Crop type j3e r VIv( ti C,-r -z e .S a 1 / ,r a .7 2 Cor n LJ h e i4 6e,,'tJ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes IdNo
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 ZNo
16. Is there a lack of adequate waste application equipment?
❑ Yes VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes O'No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes j�No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes /)�rNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes eZNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes pfio
24. Does facility require a follow-up visit by same agency?
❑ Yes )2fN0
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Fz(No
NO—*i6la0#0S:or- dgficieno" mere -h ed. d6 Wid 4his'vis. it. - Yob will-reeeiye Rio tuir ft
c'resporidenke: ahai uk this visit .......... .
Comments (refer to_guestiori #): Explaid any YES answers and/or any recommendations or.any other comments . z a
Use:drawungs of facility to better explain situations. (use additional pages: ats necessariy)
N R
)S . )gee)Ure
1; •tee c 6 o -4 r, � 4o sp � 14cs I (e co,,, me.n�f a�,`o ►� r,
q. b e )a Ir.s e eA 1.a ,r1 s4 e rr 6(e,)04 w r-{-t, !�,
W 1) Geq,; p,-, cve-071.f Q., 4�,e `2 ror rn5-
D�e��rlt are well kef
Reviewer/Inspector Name p l-� G ti.�'�r 1
Reviewer/Inspector Signature: _ _ Date: _ g/pQ

Facility Number:,?/ - Date of Inspection 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 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 ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Pf 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? ❑ YeslFzIN0
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,,ETNo
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? ❑ Yes ❑ No
JAdditional.-Comments:andforDrawings:
J
5/00

Rc.ised 4p:i120, 1999
JUSTIFICATION &. DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 3( -qd4 -_- Operation is flagged for a wettable
Farm Name:--WW acre determination due to failure of
On -Site Representative:
Inspector/Reviewer's Name -.
Date of site visit:
Date of most recent WUP:
Annual farm PAN deficit: / pounds
Part 11 eligibility items) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption El 1;2 ,E3 1_4
Operation pended for wettable acre
determination based on P1 P23�'
Irrigation Systems'),_ circle r Qhard-hosetmveier, 2, canter -pivot system-, 3. linear move system;
�. stationary Sprinkler system wlpeimranent pipe; 5. stationary sprinkler system wlportable pipe;
B. stationary gun system wiper zanent pipe-, 7. stationary gun system wlportable pipe
PART 1. W A Determination Exemptions (Eligibi14 failure, P ari 11, overrides Part I exemption_)
i=1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2, Adequate D, and D.2/D3 irrigation operating parameter sheets, including trap
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operatlrig parameier sheet, including map depicting
wettable acres, is complete and signed by a WUP_
E-". 751/10 rule exernpiion.as verified in Part 111. (NOTE:-75 % exemption cannot be
appiied to farms beat fail the elioibiiity checkiist in Part it- Complete eligibility
checklist, Part 11- F1 :=2 F3, before completing computational table in Part 111).
PART -11.75% Rule: Eligibility Checklist and. Documentation of WA Determination
Requirements. WA. Determination :required . because_operaiionlailsnne of the-iigibiiiiy
recuirements listed:helow:
=1 Lack.of�creaoen►i7ichsuiiadn�verapiiicanar��fast~>hater�(P}�Nj onzpray-
Fiel�(s)�CCCri]int]'ib7am7'S�aS'�iWoy a1��3i iTrlGa'IIon3�'LoL{lc.�- .
2 Un :learjIleoible-nr lack o; inforrnation/reap.
_173 Obviousaield jimiTtaeons-(numamusijitcnes;sailure zo;dar;uctTequired
bufferlsetback-acrBaoe;mr25%Dirtotal:acreag_zidentineddri -CAWMP..:iriciudes _' _
small,-irregularly-sraped�ieids-�i]ics:less#r�an �crns�oriravalers�r.lass ran
2 acres `ior.stationary�sprinkiers).
r4 WA determination required because CAWMP credits-field(s)'s acreage -in excess
of 75 % of the respective field's total acreage as noted in' able in Par Ill.

-� Facility Number _--
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
NUMaEFIELD R NUMBER' .2 =r��ia�RE= CAACREWMP. FIELD COMMENTS:'
FIELD NUMBER'- hydrant, pull,zone, crpoint numbers -may be used in place of field - numbers deDendlnn an CAWMP
and type of irrication •system. , r pulls, etc. crossmore-than -one field, irsDectorireviewer Will have to combine fields to
calculate 75% field by field 6eterminaiion Tor exemption; mtherwise operation will be subject to WA determination.
FIELD NUMSER2 - must be clearly delineaiad Dn-map.
COMMENTS' - back-up fields with CAWMP a:-Feage exceeding7a a of its total acres -and having Teceived less.than c0%
of its annual PAN as -documented tulle 1-arm'sprsvious-two years' (1n57 & 1996) of irricationTeCords, cannotserve-as—the
soiv basis-forFequirina a WA Determination_LPack-up: ieids mustbenoted in the-cQmrnentse_r-fion:and must -be accessible
by irricaiion system_
mart IV. Pending WA Determinations -
pi
Plan Jacks doll owing information-,
P2 PlanTevision Tnay satisfy7..5% rule based on adequate overall PAN defichh-and by
adjusting all field acreageza below 75% use rate _
P3 Other (iefin process of installing new irrigation system): e,� _ QUIP ti:�

V
�� k D�vtsionraEWaterQt3ality
x
Q_Dtvision oESort and Water Conservation,
s" r� Q Othec`Agency7&
_
Type of Visit P Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit t�(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
ate of Visit: ��Jl-G� Tune: a'�. Printed on: 7/21/2000
Facility Number fi
Q Not Operational 0 Below Threshold
)4Permitted © Certified ❑ Conditionally Certified ❑ Registered Date Last If or Above Threshold:
e ���-k-R�� County:.... ..�--i .``"- .........................
FarmName:..._....�.................�..........................................................................................................................-..........................
OwnerName: ............. Phone No:......................................................................................
Facility Contact:............................................................... .... Title Phone No
MailingAddress: ............................................................................ ........................................ .................................................................................---- ..........................
Onsite Representative:-Gt..F-.?'.._, Integrator: _... ,,,,
......................................I....---........................7................... ..............................
Certified Operator: ............ ............. ........................................................... Operator Certification Number:,
Location of Farm:
..
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��<<
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 10 Layer I I❑ Dairy
Feeder to Finish 2�QCJQ ❑ Non -Layer I I❑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 -an Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream: Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
gNo
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyancc man-made?
❑ Yes
[]No
b. If discharge is observed, did it reach Water of the State:' (If yes, notify D1�4�Q)
❑Yes
❑ No
c. II' discharge is observed. what is the estimated flow in gal/min"
d. Dees 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
I�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
qNo
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
kNo
Structure I Structure: 2 Structure 1 Structure 4 Structure 5
Structure 6
Identifier: ..--------- .......................... .................................... .... .............. ................. ..
Freehoard (inches): (�
5100 Continued on back

Facility Number: — Date of l.aspection 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
YNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
J�'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
k No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
NNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
W No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
NINo
] 1_ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
kNo
b
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
JgNo
b) Does the facility need a wettable acre determination?
❑ Yes
jKrNo
c) This facility is pended for a wettable acre determination?
❑ Yes
[�fNo
15. Does the receiving crop need improvement?
❑ Yes
N'No
16. Is there a lack of adequate waste application equipment?
❑ Yes
VNo
Required Records & Documents
IT 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
ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�kNNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
21- Did the facility fail to have a actively certified operator in charge?
❑ Yes
9fNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
&No
Oe/ discharge, freeboard problems, over application)
❑
23- Did Reviewerlinspector fail to discuss review/inspection with on -site representative?
❑ Yes
ArNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
NrNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
WNo
�: 10-viglati6ds;or deficiencies were ngted during thi-s:visit - Y'ou :Will •receive 1io f*ukther : :
. • . - corresnoncieitce: about this :visit. . .............:::::::::::::::::::: .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
v)� ?"_4 V c�c'_
1(q) lie 4, 1'_4 wj"e- a /, AXA—P
fl h r r 1
L.
Reviewer/Inspector Name �� �`d--3�1r3 700 x oDac
Reviewer/Inspector Signature: Date: (= ( S GSJ 5100

EPrinET_
Number: - pate of Inspection
ted on: 712112000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 3Wor below A Yes ❑ No'
liquid Ievel of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 11N0
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 �No
32. Do the flush tanks lack a submerged fill pipe or a pei•manent/temporary cover? ❑ Yes OkNo
bona - omments'an or_Drawings:
J
5/00

i O.Division of Soil and Water Conservation'--0 eration`Rei�ew
13 Division of SoWand Water Conscirvahon Com Lance ect�on
p-
.� Division of Water:Qualdy Compliance iinspection '` .
W _..:'.Othra
er Agency Opetion Review
Routine 0 Complaint 0 Follow•-u of DWQinspection O Follow-u of DSWC review 0 Other
Facility Number O Date of Inspection - ^Q
Time of Inspection /Q : DO 24 hr. (hh:mm)
© Permitted aCertified © Conditionally Certified [3 Registered [3 Not Oper-a-77-711 Date Last Operated:
Farm Name: t 51 C ke .......KLAl'.if4 ........ r fm ......................................... County :.......... .L_./i:I'.K)................... .............................
Owner Name:........ � J..� �----_... K�::1'1A t1.. Phone No:.......1. t. ��.9. .` .. ........................
1...
Facility Contact: ... .............................. Title: ........ 11. .. ........_ . Phone No:...................... Gt-t.> Crl.
Mailing Address: ......I.A..T��
........ T� ...... r..BUG,........a.a........... j44.11.k...... �...nz..2 t.
Onsite Representative:.................................................. .... Integrator:.....0...........................................
Certified Operator:..........�..!'�.......!.!.hl Operator Certification Number: �9_Z3,A
............................................. ...............
Location of Farm:
A6
...................................................................................................................................................... .................... ........................................................................................
Latitude • �� Longitude • ��«
Design Current.-`Dsigp Curreiit--
Design
Capacity Population Capacity
Population,
uurlraetniotn,
.Swine Pey
[3 Wean to Feeder ❑ Layer go airy
Feeder to Finish pap ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder [] Other
❑ Farrow to Finish - - Total -Design Capacity
❑ Gilts _
❑ Boars Total SSL-W
_ Number of:Lagoons . Subsurface Drains Present ❑ Lagoan Area
Holding-Pond`s /Solid Traps L._ ❑ No Liquid Waste Management System
DischalM s & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Spray Field Area . -.
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1
Identifier:
Freeboard (inches): ........-.4-l-...--...
Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes [f No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes [� No
❑ Yes INo
❑ Yes [Z No
❑ Yes [%No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes [XNo
Continued on back

.- Facility Number: 31 — yob Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenatce/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Lo45�l &.-m da r1 tt e . , t' C� tj so T rd"'o n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio y;iolaiitoris_or deficiencies were noted ditritng s:visit. Moir will reeerye rio further
corres�ondenee. abhut this visit. . . • .. • .. ..
❑ Yes 10 No
❑ Yes �(No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes N No
❑ Yes b(No
❑ Yes [(No
❑ Yes ❑ No
El Yes � No
❑ Yes �(No
❑ Yes q'No
❑ Yes VNo
❑ Yes '� No
❑ Yes No
❑ Yes No
❑ Yes 4No
❑ Yes k No
❑ Yes _t�No
❑ Yes �No
Comments (refer' i qOe 66n #).:;Explain any YES answers aad/gir any -recommendations br'any other comments:
Ilse drawings of facility to better explain situations: {use addition/al�°pages a//sMecessary} nn �J
I -AL PrOGe,SS of Plor,74'► (,JAJ ,� r Dl) tl`G1J5
Phut_ �S some. Waal • �!} i jCerrtf—✓ Op is aayl aAcL. Samf—
w� 5 n ti c.lj Z y k t`%.�'L h� i s t' Pro `jo �-
J
Reviewer/Inspector Name a r
ri
Reviewer/Inspector Signature:) Date:
3/23/99

-Facility Number: 3 hate of Inspection Odor Issues
Issues
e,-Z6::1Does 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? ❑ Yes (SKNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes C�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 'qNo
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 [VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes O(NO
,,2#i' Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
I-A-4ditionaL Comments an or' ravi ngs
3/23199

Longitude
De`s. ign ',Current
Poultry ``'.Capacity Population Catt'
Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
3Rr.,z i °r_ „`'�•�., - -,'„ ti ,+,,
10 Routine O Complaint 0 Follow-up of DWO inspection 0 Follow-up of DSWC review 0 Other
"Date of Inspection 1 71P L ,I-?
Facility Lumber 3
Time of Inspection 2: Po 24 hr. (hh:mm)
©Registered d Certified E3 Applied for Permit O Permitted U Not Operational Date Last Operated: ..........................
Farm Name: fir ......................... County:.........bock".................................. ......................
Owner Name: ..................:. �.�¢'e... f� �Y�� Phone No:...��C.Q�.Z`1. :. a .....................---.---............... ...-.... .......... .................................................. ...,
Facility Contact:.... ................................................. . Title:...................... ......... Phone No:
............................................................................................................
Mailing Address. C�4 e► cn......... .............. RU� s~�.i e... T'_N .......... •..................n-.----
............
Onsite Representative .................4Aj .. Integrator:.. ....................................
Certified Operator:............................................................................................................... Operator Certification Number...................
Location of Farm:
g' 5.1....{Z3�..D :�..kr.f. s 1
..................cw.c................ a.....i?.... :....C�,x.......... 3is:.........-......-.....................................................................
F,
...................................... ..............................:.....................................................................................................................................•............... .....__................. ...............
Latitude r_�' 1 0"
�Des►n Current
Swine '.:.` Ca0ac1ty P40Dulatioti
...................
❑ Wean to Feeder
Feeder to Finish
opt.
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes Wo
2. Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originated at: El Lagoon' El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what•is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes �j]( No
❑ Yes J ] No
❑ Yes
E" No
❑ Yes
EANo
❑ Yes
%No
❑ Yes
7' No
❑ Yes
No
❑ Yes
No
Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed! ❑ Yes V No
Structures (Lagoons,llolding fonds, Flush Pits, etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 06 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 0
Identifier.
Freeboard(ft):............3.....................................................................................................................................................................................................
10. Is seepage observed from any of the structures'?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
0 Yes 04 No
❑ Yes M 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 IA No
Waste Application
14. Is there physical evidence of over application'? ❑ Yes C§ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............C.IXi2......... ........ so .6u...-:................"kwvu1 ..........,bp . ............................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? nYes ❑ No
17, Does the facility have a lack of adequate acreage for land application? ❑ Yes D9 No
18. Does the receiving crop need improvement? U 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? 1P Yes ❑ No
21. Did Reviewer/inspector fail to discuss reviewlinspection with on -site representative? 0, Yes 1� 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
0 No.violations or deficiencies were` noted- during' this. visit. You.will receive no ftirtfier
carre O idence about this visit... . • .. ..:. . .
Cominents:(refer_'.to question #): -.Explain any tS.answers and/or any recooimendations;oi any other, comments
Use drawings of fac'riity tci betfer explain situations. (rise additional pats as.necessar�).
..,,.
t2. CbrkiNVe -2t f`s ko t6yer. d;Vk L 'Al. tk)vcr Ctc, WfAk S F,445 w,oyAHd
t
+
b Fcr,LUt o„r -Cc+'v, tM-c`�� h`SfYN kfOs 64 Hof I� i kc) +. hJvr', N�tr KPw-�y
ioA. g d o Seri loexvr .r. SVYT 9
1,9• to"cr e" P\U5-k doe ;r.�Yz1tK
Z.2-.. C-orr, 0,.Vt� lie- CJ43 -6 +(-k- oup
ss rt t � fir. AL, ire c-vn 4s-,Sr, 4 44u 4 PAN loaAv�r vv. S61d � e t l_ VVkd
be
Dr- ,trr.")S. LCL oar des y. ;�'�• sl.,ov�a i�3t` rrc �.
�� g
`� 7/25197
Reviewer/Inspector Name s
Reviewer/Inspector Signature:_ �^ �. Date:

,ivZ� .' ' r��.. �'
"� ❑ DSWC An1mat, eed[ot Operation�Revlew
_ .. s�
�< �DWQxAnlimal Feedlot Op ration Slte Inspection,a�
Routine 0 Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 3 4 O
Time of Inspection ; Il 24 br. (hh:mm)
Total Time (in fraction of hours �--�
Farm Status- Registered ❑ Applied for Permit (ex:1.25 for 1 hr .15 min)) Spent on Review I��J
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:....__.._ —... �... ...... .««...... _.............
' .... ..... «..«..... ��..,.«]................
Farm Name:County:,.... .P11.
Land Owner Name: «_ !71l.l-« .. .... _ .«.« -.� -_.... ....._ Phone No: _,.....: �P_` ..... _................ «...
Facility Conctact•
..... .......«........ .«..... ..«....... . ..................... Title: «.......««.------....«.« .... ......... _. Phone No .........
Mailing Address:.. A.L-..............'":.....«.......�LQ`` .'�4 ..... W.... ......... �t«.1. f « ...... «.... _... 2.... �..
Onsite Representative:...f�;,aG�/�..... 0:?'.. _.... _......... ...... _....-. Integrator:.«14
1'..�
Certified Operator: ....«.«l.:« :'L. ...__,...... Operator Certification Number: 1 7� �.d
4�
Location of Farm: /
ii-ic.�r�► ..... ,p �. !«.......1.7�2�.n. _....: �::..««..............._........... ....... .«................ .... ._............««..... ......... « «....« «....._F
Latitude • d0 `®" Longitude ©' F7g!4
[="
Type of Operation and Design Capacity
E�o- Desga, Current aXxs�'
Des�ga Currentx Aes�gn y Current
Sw�ue: Pouf g Cattle
Ca aci FPo ulation, _ t!y �Ca ace Po ulahon ..Ca acePo ulahoa .
Wean to Feeder ❑ er ❑ D _. -
eeder to Finish ❑Non -La er ❑Non -Da'
Farrow to Wean
Farrow to Feeder Total D 19 A- aeity `' 4 `
Farrow to Finish
_ .... ...��.: _:. �n. - � Total S
"s
_❑ Other , f
Number ofLagoons %Hv1drg Ponds l ❑ Subsurface Drams Present
.
�N y Lago ❑ on Area ❑Spray Field Area y
General
I. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gathnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes allo
❑ Yes gNo
❑ Yes 25 No
❑ Yes E4 No
[:]Yes
RNo
❑ Yes
allo
❑ Yes
to No
❑ Yes
allo
Continued on back

Facility Number:...,,,.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes allo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes MNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes J.No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ®'No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
`�.:.. .... .. ........... ,....... _..... ....... -- ................. ... ....... _....... _ .... .........
......_
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type b. ter.. ri '-� .:..1........... ......... ..., ._......_.......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a Iack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes Jallo
❑ Yes KNo
Yes ❑ No
❑ Yes, JqNo
❑ Yes No
4
❑ Yes ® No
❑ Yes MNo
(a Yes ❑ No
❑ Yes ®No
❑ Yes 64 No
❑ Yes Eq No
❑ Yes 19 No
❑ Yes ® No
IN Yes ❑ No
Comments (refer to question:#) Explainany YES answers:and/or�any recommendations or any other comments
t
Use dr:of facility to better explain situations =(use addrtionalpages as necessary}F
,. =
iZ . Crt-t rt q o o v �e f� v-2 (,a v.2.r Q-s 1 c- b {... s a — +\u.Ks Woo �0' w a 4
t a v t" �tl e 4 a v t4e .— w a Mr
Z'J p ,�-�q o a (� �p
p 1 4+ ¢-t`9 o �e.r 7 1 v. t� d.�, , ;
Qi#1 < < <G C t
' it V y 4 1 i +'-e- C-a -tf-3 th V"-, r p V-V f-t" c--c,.. L c v 1 a to t? Yt
�% ' c v .r _ `� . c� �,.. to of C a-,. cZ .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
t
cc: Diviston of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. 7 l _ /)C/
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: g, , 1995
Time:
Farm Name/owner:�,��
Mailing Address:
County: n-
*1
Integrator: ! vb u R p 4�6 Phone: l� � a Y 7 all w
On Site Representative:Phone:
Physical Address/Location: _ _41e _ j.A-4
Type of Operation: Swine'. Poultry Cattle
Design Capacity: a ico �F�iL- Number of Animals on Site: c a v
DEM Certification Number: ACE DELI Certification Number: ACNEW
Latitude: 3y bu' (!L ." .Longitude:_ I'l 1` _" Elevation:- Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)Ce>sr No Actual Freeboard: -Ft. �_ Inches
,;d t
Was any seepage observed from the lagaon(s)? Yes or No Was any erasion observed? �
ar o
Is adequate land available for spray?(�Oor No Is the cover crop adequate? Yes org)
Crop(s) being utilized: _ (70Sn1
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? jces r No
100 Feet from Wells? r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 1& If Yes, Please Explain..
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes oro "
Additional Comments: a i�,;y P &!a ,t LAt-ym dV wb, pw I i
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed"