310422_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

OA ifision of Water Resources
Facility Number - �Z Division of Soil and Water Conservation
� Other Agency
Cype of Visit: 0 Corn l ce Inspection Operation Review Structure Evaluation Technical Assistance
teason for Visit: Routlne ❑ Complaint Q Follow-up 0 Referral D Emergency Q Other D Denied Access
Date of Visit: 'Z. t Arrival Time: A!' Departure Time: 7*4 f'- County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: par Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: W 6 7 f
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Wet Poultry
Resign
CapaeIty
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
I
JLEayer I
Dairy Cow
Wean to Feeder
'�
Nnn-La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
D . P,oultr.
Layers
Non -Layers
Pullets
Turkeys
Turkey Puults
Other
Design
Ea aei
Current
'pop.
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
[]Yes
5 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ of
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EN o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

lFacifity Number: - Z Z_ jDate of Inspection: -%-. IW7 71
Waste Collection & Tr atment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes LJ No [DNA ❑ 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
C3'-No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
ErN,
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ 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 210�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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [; Io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
eNo
❑ 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?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes rNo
❑ Yes
❑ YesMn
❑ Yes �rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ld No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFaeffity Njimher: - 1Z. Date of InSpec flon:
Z x
24.,Did the facility fail to calibrate: waste application equipment as required by the permit? ❑ Yes [ -N- ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes - No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No :INrA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes a rNo❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Z rNo ❑ NA ❑ NE
❑ Application Field ❑ LagooruStorage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes � ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? D Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
comments:{refer ta'ijiestion".!#}:ixplaiiiany�YESanswcrsBandlor.
atiygatldltional recomtrieiidatidn"s�orliipydtlierPcnmmei�t j
�;�.,=k . y:kiolfiZttWr plains -yet , • Use.addltlottal oa`ges'aspnecessa )" r ��i. �� U§e_drawin s offa�ill ato i>et#er:ex lainssltuatinns,( }: 4:v��::� xM
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
4
j --0 r l
Phone: 1 [0 11 730Y
Date: !D-2
21412015

Type of Visit: ompliance Inspection 0 Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Visit: Routine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: Arrival Time: r 3 Departure Time: (R County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
/►-. r �K-'e f {-III C"-
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 7 [7 T
Certification Number:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
❑ Yes [3-NI5— ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [] No . ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

[Facility Number: If ? Z jDate of Ins ection: Cb e
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ o ❑ NA ❑ NE
a, If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5, Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ 'No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes rNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aimlicatiort
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [;F1';ro^ ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ON ❑ 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 Sate 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 to ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [] Yes VN
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes❑ NA ❑ NE
acres determination?
€ 7, Does the facility lack adequate acreage: for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available''
20, Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes rNo
❑ Yes
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Other:
Er -Ye; ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections €udge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E105o ❑ NA ❑ NE
23, If'selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility umber: V 2 Date of Ins ection: v
24. laid the facility fail to calibrate waste application equipment as required by the permit? es No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fo ❑ 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ltJ o
❑ Yes ►LJ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes EZeNo ❑ NA ❑ NE
❑ Yes E f No ❑ NA ❑ NE
❑ Yes
o ❑ NA
❑ Yes Ee:�VN
❑ NA
❑ Yes❑ NA
❑ NE
❑ NE
❑ NE
Comments (refer to g6estion:0) Explain any YES. answers;and/or: any.addit€onal.recorninendgtions:nr any other,commcnts:
Use drawings'uf, facility tb, better explain sltuati6as.[use.ildditional pages es.necessary)
r C j` {t m r0 n ,.d
r
.-oa b r' c n r Y r r &] 'e {
�04t C O�y �� v (S 5-% r' e •_54. tt/t y, r C d {�' 1
J
��� C t���► 10 3 So z °a`7
a �. r cf . �� c..t C{ 9 n� �.en F � � •►
ri S A p�j -
L r ^--t i- • C re(.s Ct e c, 41T
❑ , s r 0 LA--< e r1c n l C ev
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: 10? e 1 7.) R 1
Date: TX
21412015

ZL
Type of Visit: &Compliance Inspection Q Operation Review Q Structure Evaluation p Technical Assistance I
Reason for Visit: (Z Routine Q Complaint Q Follow-ue Q Referral Q Emergency Q Other Q Denied Access Ij
Date of Visit: Arrival Time: ® Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address;
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: (�t--- H.4 r P e-/~ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: J -7.
Certification Number:
Longitude:
Design Current
Design
Current
Design
Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop,
Cattle
EME
Capacity
Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Z
�9
E
Non -La er
DairyCalf
Feeder to Finish
Dai Heifer
P
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D • P,ou[t
Ca acit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gifts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yesg�No❑ NA [] NE
Page I of 3 21412011 Continued

FacilijZ Number: 3 - 2 Z— Date of Inspection: 1 f-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZrNo ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes n—No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify OWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F�rNo ❑ 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 Ll No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ef'No [] NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E:fNo
❑ NA
.❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C.J o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
/ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[fNo
❑ NA
❑ NE
Reauired Records & Documents
-No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
El
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAW MP read ily avai [able? Ifyes, check
❑ Yes
[3No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 1. 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
❑ 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
[%rNNoo
[] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2 0
[] NA
❑ NE
Page 2 of 3 21412015 Continued

li acili Number; - qZU1 Ds ection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes; check ❑ Yes ErNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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 tiie 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?
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ErNo ❑ NA ❑ NE
[:]Yes 7 No ❑ NA ❑ NE
[]Yes No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes u No ❑ NA ❑ NE
❑ Yes 2"Nco
NA ❑ NE
Yes ❑ NA ❑ NE
,.......
Date:V_1L1
I-
21412014

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: k.ZLL Arrival Time: eparture Time: County: Region:
Farm Name: / /IvI
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: r
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: l�7,
Certification Number:
Certification Number:
Longitude:
Design Current
Design Current Design Current
Swine Eapacity Pup.
Wet Poultry Capacity Pop. Eattle Capacity Pop.
Wean to Finish
La er Dai Cow
on -Layer Dai Calf
Wean to Feeder
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D . 1?ouIt Ea acity I'o P. Non -Dairy
Farrow to Finish
La ers Beef Stocker
Gilts
Non -La ers
Turkeys
Beef Feeder
Boars
I lBeefBroodCow
Other
Turkey Poults
Other
Other
Discharges and Stream Imuacts
1. Is any discharge observed From any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ,2fNo ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes ;21�v ❑ NA ❑ NE
❑ Yes -ErNo ❑ NA ❑ NE
❑ Yes 21"No ❑ NA ❑ NE
❑ Yes � o ❑ NA ❑ NE
Page l of 3
21412011 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
"FelNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _� l
Spillway?: T
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to t e integrity of any of the structures observed? ❑ Yes ,Eno ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ 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 [�'-'RIo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ja'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes •E:rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes AffNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes jZNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload [D 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 .2TNo
❑ NA
❑ NE
15. 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
❑ Yes .13-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes JE3No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 4�o
E] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes jallo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E31;o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes oN❑ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]'Yes ONo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued
If

Facility Number: -V IInspection: /
24. Did the fa6lity'faii to calibrate waste application equipment as required by the permi ? ❑ Yes ZfNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ffNo ❑ NA ❑ NE
the appropriate boxes) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure.a.phosphorus loss assessments (PLAT) certification? ❑ Yes ZrNo ❑ NA ❑ NE
/T
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J:?No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
;�],No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below,
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PIo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency`'
❑ Yes
JZ 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).
ss �
CP
I.
Reviewer/Inspector Name:
Reviewer/Inspector Signature: / �At"
Page 3 of 3
Phone: y001,
Date: /."IV
1,2141y,1

F
f Visit �Co/mpliance Inspection Q ❑peration Review Q Structure Evaluation Q Technical Assistance
n for Visit Q Routlne Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: �/; [1� departure Time: County:
Farm Name: Gr�! Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative:. ' �f �(",''-,n/i
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = 0 = ` =" Longitude: = ° = . = "
Design Current
Swine Capzc iy Population
Design Current Illesign
wet Poultry Capacity Population
Current
Cattle Capacity Population
❑ Wean to Finish 110
Layer I I
❑ Dairy Cow
❑ Wean to Feeder I
J[j Non -Layer I
[jQairy Calf
❑ Feeder to Finish I I
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish
La ers
El-BeeCStocker
❑ Gilts
❑ Non -Layers
ElBeel'Fecder
❑ Boars
❑ Pultcts
❑ Beef Brood CnvJ
Turke s
Other
❑ Other
❑Turke Poults
other
Number of Structures:
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the Stater (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 ICJNo El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
❑No
El Yes
["No
[I NA
[I NE
❑ Yes
�No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: — _ Date of Inspection
Waste Collection & Treatment
1.
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑rNE
a. If yes, is waste level into the structural freeboard?
❑ Yes ,ENo
❑,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 Z No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ZNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P*o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5�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 [l Yes [,-2'No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
14, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;2'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ZNo ❑ 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 ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Fe No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�T No
❑ NA
❑ NE
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
9No
❑ NA
❑ NE
g �.[ �n �.kY.. � •' 3'c'.e .a •: R:,:. �iF•iy �::'..',�y- �.'�. " � �8 ;i..' '$. ` . �.
r;^,.;:.:.... .ruv. .� .f ..f....A,t'. �tR9''-$ .."". mn.,
Comrfiepts (refer;tnbquestinn #}, ExpIaI any.`Y Syanswer.s. audlor any recummendatlorts or. any other comme ts. .
i]se: lrawtngs of facility tosbelter explain situatlons:{use``a��d�dzi�tio►alpp�aSges asnecessary}�����
•y . `F R..D..Fr . -r z 3i£wi�.;w LB"..'.:°� .k , " a '� j..i � .� �3�3 A9'�:SkS. k�� �����. �° i _- • �
Reviewer/inspector Name 211 ` yx ., . _ Phone: 91
ReviewerAnspector Signature: Date: E+ _�
P 1 2 -'f ` y 12/28/04 Con' dieted
uge of i+• ,t-

Facility, Number: — , Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZfNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ErNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Z'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes,Mo
❑ 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?
Cl Yes
Z 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
;3"No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,.,/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative`?
❑ Yes
1,,,��Q,,
❑ NA
❑ NE
lLdNo
33.
Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Addifignal:Comntents andlor;Dra►vin s:
p
�,' _ p
'.,'3�: *:.._�'S baits ..41
014
���,•r
10007
J
r _S14VSe- lebd.
cr e
NZ
of
f etoref
ltak5o
'00 � - 0 5
lei !N �vc�1
Page 3 of 3 I2/2VO4

e
JO-Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation � r
Q Other Agency
Type of Visit 9eompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit _i2r1ftoutlne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Dale of Visit: Arrival Time: Departure Time: County:
Farm Name: ! Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
ty
Certified Operator:
Rack -up Operator:
Location of Farm:
Phone:
Phone No:
Integrator
Operator Certi ation Number:
Back-up Certification Number:
Region:
Latitude: = o = 4 ❑ « Longitude: = n = 1 0
Design Current Design. Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -La ei
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other..
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'!
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population.
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Cow
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?
..a
❑Yes ,ONo El NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
El No
❑ Yes
�
❑ NA
El NE
❑ Yes
No
❑ NA
❑ NE
12178104 Continued

0
Facility Number:
Dale of Inspection G
►Voste 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?
Structrc I Structure 2 Structure 3 Structure .t
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboarri (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
Oe/ 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 91No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Structure S Structure 0
❑ Yes 'VNo ❑ 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 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 E ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) I
9. Does any part of the waste management system other than the waste structures require [] Yes YJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Antviication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes UfNo ❑ NA ❑ NE
m aintenancelim provement?
11. Is there evidence of inwrrect application? if yes, check the appropriate box below, ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes &o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ErYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'( ❑ Yes 2<o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes''+Io ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A
Reviewer/Inspector Name Phone;
Reviewer/Inspector Signature: f' Date:
12128164 Continued

Facility Number: 7 Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Ccrtifcate of Coverage & Permit readily available? ❑ Yes 4o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z o ❑ 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
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O o
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,�I No
❑ NA
❑ NE
25.
Did the facility tail to conduct a sludge survey as required by the permit?
❑ Yes
2No
❑ NA
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes Z'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 13'eNo
❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EafTo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�Ko
❑ 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
;211�0
❑ 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
❑ 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
P"No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
e No
❑ NA
❑ NE
Additional Comments and/or Drawings:
P��►�� t�r .�
`r!
IT. &04

_7l
Type of Visit Compliance Inspection
a Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 'p-Routine Q Complaint
Q Follow up Q Referral a Emergency Q Other ❑,Denied'Access e
.�
Date of Visit: / Arrival Time: Departure Time: County: C�
Region:
Farm Name: Ir ,C ���'
_ rye Owner !;mail:
_-
�
Owner Name:
Phone: `�`�
�+`� • �
Mailing Address:
! 1
Physics! Address:
l l%
Facility Contact:
Title: Pho a No:
Onsite Representative:
v Integrator:
l���
+` fr`,`
Certified Operator:
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
l ail r
Location of Farm: Latitude: 0 e Longitude:
+
Design Current
Swine Capacity Population
Design Current Design Current
Wet Poultry Capacity Population Cattle Capacity~ Population
❑ Wean to Finish
F
❑ Layer I Cow �
Non -La et I I❑ Uai Calf
❑ Dairy Heifer
Dry Poultry El Dry Cow
Non -Dairy
❑ N ers 10 Beef Stocker /
!lets ers Beef Feeder
Pullets
❑ Beef Brood Cowl i
❑ Turke s r
❑ Turkey Puults
Other E� Number of Structures:
can to Feeder
. ' IEI
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
Gilts
E13 Boars
Other
❑ Other
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

IiacilityYNumber: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural Freeboard?
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
O'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
PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed []Yes
J]'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
[ -Ado ❑ 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 outer 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
[D No ❑ NA ❑ NE
maintenance/im pro ve m cnt?
11. 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Z-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
[3-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;I-5o
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name - Phone: &Q —, 9%��
Reviewer/Inspector Signature: Date: V113 d
12128104 Continued

Facility Number: 3 — L L Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1�lNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 12-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0 NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes EYNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 12 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA ,9NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes -Erlo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes JD -No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ['No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes Pll�o ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ;21�o ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes o ❑ NA ❑ NE
Additional Comments and/or drawings:
o. '/
3/lyl-1--7 �' y
D d
�� ,S�(�+G � CGYr►� V J c�
���/!.•[JC� � �• � � W G es [�1l�'r�I SC� �� J�Grt� �a G/� .3 � �-•
� L� ii% r '� •�
e's
6sJ 4
12128104

Type of Visit erCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit QwRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Time: 37 Departure Time: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phon o:
Integrator: _1,;z
-,,? -
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = L =11 Longitude: = o = 6 =
ji
Uesign Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
ILI Layer
❑ Dai Cow
can to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turke Poults
❑ Other
Number of Structures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
I Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 1P•No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
[]Yes
Z"NNo ❑ NA
❑ NE
❑ Yes
dNo' • ❑ NA
,
❑ NE
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 F] No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
ElNA
ClNE
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 0'No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ep
4. Does any part of the waste management system other than the waste structures require ❑ Yes ❑'No ❑ NA ❑ NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,D-No ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ Ny ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 14% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop' Window El Evidence of Wind Drill Application Outside of Area
12. Crop type(s) ( f 0 � , 5 `"S , Ag O I %I .— < L 67,a1,il ;-C,1)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes J No
❑ NA
❑ NE
15. 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 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes /❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes /0 No
❑ NA
❑ NE
Comments. ('refer to question #): Explain any YES answers and/or any. recommendations or any other comments.:`
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name y� Phone:
Reviewer/Inspector Signature: Date:
Pape 2 of3 1248104 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 WNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V main Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Cl Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[>o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit P Compliance Inspection Q Operation Review D Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint O Fallow up O Referral O Emorgency Q Other ❑ Denied Access
Date of Visit: ®
rrival `Time: .�
Departure Time:
County:
Farm Name:
/r
,*-7
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: l� 46r
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: ❑ o ❑ I = Longitude: = ° = I =
61
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
can to Fini
Went e
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other °
Dry Poultry
Pullets
LI Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part ol'the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Fleitei
❑
Dry Cow
❑
Non -Dairy
❑
Bec[Stocker
❑
Beef Feeder
❑
Beef Brood Cow,
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 (gailons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes El No ❑NA ❑NE
❑ Yes .rJ No ❑ NA ❑ NE
❑ Yes)2<0 ❑ NA ❑ NE
12128104 Continued

Facility Number:'- I- Date of Inspection
W aste'Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes .,8'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed freeboard (in): 001
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Zj0No ❑ 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 ;;�Ro ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 211.4o ❑ 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 ZINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
1 I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 types)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZrN❑
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',❑
Yes
;3No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
[]Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;Ko
❑ NA
❑ NE
..'ei. ti�'�'�-'.: � • u rye-k...t �. .'S: vl'..� ���.... .i _i. .i �_9'si�. ea.^.,k-= .C..:.
cillik&.1ietter:eiplairi Situ"a, dns (ose additiorial
Reviewer/inspector Name Phone: IU�a7 s = +J
Reviewer/inspector Signature: Date: ZZ g v
12/28M4 Continued

Facility Number: Date of Inspection �
s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,2'Kio ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,ONo ❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ZYes *No [:3 NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking X
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 ONo ❑ NA ❑ NE
23. If selected, did the facility flail to install and maintain rainbreakers on irrigation equipment?
24, Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP•?
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal'!
30. At the time of the inspection did the facility pose an odor or air quality concern?
1l' yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewcr/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
ZNE
❑ Yes
❑ No
❑ NA
Z E
❑ Yes Z No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes .ErNo
❑ NA
❑ NE
❑ Yes > Z No
❑ NA
❑ NE
❑ Yes ZNo
❑ NA
❑ NE
❑ Yes ;TNo
❑ NA
❑ NE
❑ Yes ;Nn
❑ NA
❑ NE
❑ Yes ;;,No
❑ NA
❑ NE
A"ditlonal Comments antllnr Drawings:
Cj C Fcc y end s a;� ffrn red �f � 5 ,
re c � � I
eSi�rd �s l�.Ss aver-
0/1- 14 a0y'aa'q/
J
1>11-7 00 Cl
cJ
12128104

A:
IType of Visit _(]'Compliance Inspection Q Operation Review n Lagoon Evaluation I
Reason for Visit 911110*'utine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number "ate of Visit:
Ef
rmi Petted P ertitied © Conditionally Certified 0 Registered Oo
�, e
Farm Name: .. r ! LG�I'... C%itY� ...........................
ID Net Operational D Below Threshold I
Date Last Operated or Above Threshold: •.
County: .....:,�A ........................
OwnerName :........ .......................................... ........................................................................ Phone No: » ................... ............ .....................................................
MailingAddress: ................. . ............. . ............................................. ... . ....................... . ... . ... ...........................................................................................................
Facility Contact: ...................................... ...�..f �./...»......................................... .Title: ... ..................................... ....... ........ Alo
Phone No: ... ..........................................
Onsite Representative: ................................ Integrator:.......................................Certified Operator:.. ........................................................................................................... Operator Certification Number:,.........................................
Location of Farm:
wine © Poultry ❑ Cattle ❑ Horse Latitude Longitude It
. r• ,.,
Design Current' . ' il`esigri,� ,. Current w j �+ :if :� ] llesi ' Current„
- r Imo.'• ` i,
Swi e; t �;., _
.
�,h.Ptult }. ,. �,� Cattle's =1 ; :. pK
Ca act Po 'ulation,: !� 3'. - + .: Caps act i. Po' elation J, a: _ Ca ae `5' . Population`'
to Feeder
%
❑Layer
I :
❑Dairy
fWean
[c] Feeder to Finish
❑ Non -Layer
❑Non -Dairy
❑ Farrow to Wean
,.
'aj.,:,:uj �f i . ;r i' • . ! . 'I
❑ Farrow to Feeder
;: ❑ Other
., .,. fl
..�,. .. ;
Farrow to Finish
.4
y.:,;r {
per.
L
Tata �� i' �'Capac�
E] Gilts
;,:
c. r:.:;: tis r•+ '.f .� '� I''5i r• ;;' I3 I: a .
3
Boars
' i` :{Tota1SSLW
�
mber:of Lagoons"
Discharges & Stream Imparts
1. Is any discharge observed from any part of the operation?
❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is. observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/nun?
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/EfNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;2`IQ0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;2,5o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: .............. .............................................................................................................................................................................»..................
Freeboard (inches): -
12112103 Continued

Facility Number: Date of Inspection
5..Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes ZNo
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or D Yes _ Nio
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 Pl�o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes EMo
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 ,00%
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes P401'
�'"
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ wit those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes Z190
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 00
b) Does the facility need a wettable acre determination?
❑ Yes ET90
c) This facility is pended for a wettable acre determination?
❑ Yes '2"N0
15. Does the receiving crop need improvement?
❑ Yes pMo
16. Is there a lack of adequate waste application equipment?
❑ Yes j' o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes J ' o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes '2No
19. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt,
❑ Yes RNo
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 FWo
Air Quality representative immediately.
w............ _
.,,. �.- ...f.. _..,'.. .... --.€ �.n-. .. :..:'•+�n,n�t: _ ..-.......,:-h;:€+x!..:w;:.:urr........;zn:i>r:'.nr::••:;••r,,:,..:.:.>.. ...� .:
Comments. (refer. to uestsari #):. Ex lain an .., answers antllor any; recommendations or any otltcr'comments: '
:. .... :.. €::.;:.:...:.,r:... "sl: !rr4r".
h.c � ..m�. tr .r
Use drawiags. of iacmty to better eitplain situatin (use add-iddhid pages as:necessairy)c ;' Field Co Final Notes
k
� >/C
7
c., '*s.'' x,�.; '-"' .-..... ' � : ,: r ., ,ar
ReviewerlInspector Name C ..; �,' �w c :'
' -.i :.a.: za ::W.?...kax3 :.:Yt. _: r!'i. r. } Ip:ic.i.".}� •:is
Reviewer/Inspector Signature: lef Date:
12112103 Continued

a
r�
Facility Number: 3� { Date of Inspecdon Q
Re
r
wired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
.2r90
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
1❑
Yes
(id WUP, checklists, design, maps, etc,)
-E�No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ErNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
.jfNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
<0
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
ZNO
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
f 1io
NPI}ES Permitted Facilities
30.
Is the facility covered under a NPDES#Permit? (If no, skip questions 31-35)
❑ Yes,;314o
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
[:]No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form []Rainfall ❑ Inspection After V Rain
❑.120 Minute inspections ❑ Annual Certification Form
12112103

Facilitv Number slate vi' Visit:
Ff Permitted © Certified 0 C ditionally Certified 0 Registered
Farm Dame:
Owner Name:
Mailing Address:
Facility Contact: D Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Time:
Date Last Operat or Above Threshold:
County:
Phone No; � � z1 r Y6
Phone No:
Integrator:. y "
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Morse Latitude • �• I "� u Longitude
Design Current De'segn Current )design Current
Swine Po ulation Cattle Capacity Population.
ri
Wean to Feeder I.a er ❑ DairyM
Feeder to Finish ❑Non -Laver I I ILINon-Dai E
Farrow to Wean
❑ Farrow to Feeder ❑Other
El Farrow to Finish Totat'Design Capacity
[] Gilts
Soars TotaI:SSLW
..,'N'utuber of i:agoon's
Holding PondsiSbiid;Trups
,i.'' ❑ Subsurface Drains Present
No Liquid Waste Mana en
Discharge AStrearn Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pan of the operation?
Area L_I 5 rav Field Area
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? ❑ Spillwav
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier, -
Freeboard (inches);
05103101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
to
VNo
❑ Yes
r
No
Structure 5
Continued

Facility Number: 3 1 — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
b. 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 Aj!plicatioin
10. Are there any buffets that need maintenance/improvement?
11. Is there evidence of over applica 'on? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 3o s r1j-
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?
Reglitred Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other 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?
❑ Yes JZ No
❑ Yes 0 No
❑ Yes VNo
❑ Yes RfNo
❑ Yes 5dNo
❑ Yes 'Ef No
❑ Yes PNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ YesNo
❑ Yes No
❑ Yes V No
❑ Yes � o
❑ Yes j No
❑ Yes No
❑ Yes 9No
❑ Yes VNo
❑ Yes XNo
F3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Com'. menu (r'kerjo question 0- Esplaf :zny..YES answers aadlor any recommentlatioits or any other camrnents:
Use drawings of facillty.to better ex'plai ftuatiGUL (use sdditiuital pages as necessary): Field Cnnv ❑Final Notes
eo v e ®N
Hr
Reviewer/Inspector hame
Reviewer/Inspector Signature: Date:
05103101 Continued
4

Facility lNumber: Date of Insprctinn
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? r
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.,
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes � No
❑ Yes ;�' No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
Addltional Comment% and/or Drawings: I .. .. ' .. ' .. `
7-A4JM Z�6e 640e4OW 4W41 le�5 &44�
AV/-)
��:; 7'V a
*"wn /4,; z
05103101

i♦
)Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit X Routine 0 Complaint O Follow up ❑ Emergency Notification Q Other
❑ Denied Access
Facility Number Date of Visit: Time: ® Printed ern: 7/21/2000
d Not Operational 0 Below Threshold
© Permitted 0 Certified © Conditionally Certified 0 Registered Date Last Operated or `Above Threshold:
R.�.t.�,!r....`................................ County:.......1�...................................................... Farm Name: ....... ..
Owner Name:
Facility Contact:
Title:
MailingAddress:.....................................................................................................................
Onsite Representative:1,,.!........................................
Certified Operator:
Location -of Farm:
PhoneNo:.......................................................................................
Phone No:
Integrator:......��,,, �LV...................................................
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Worse Latitude + C�` « Longitude �• �6 69
Design Current Design Current Design Current
Swine Capacity Population Poultry capacity Population Cattle Ca city. 'Po [afioa
Wean to Feeder i eW'� Q Layer i I Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑ other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
`:: Boars Total. SSLW..
Number of Lagoons
Holding Ponds 1 Solid Traps
Subsurface Drains Present 11LJ Lagnan Area 1LJ Spray Field Areff ix
No Liquid Waste Management System '` ifc,
Discharges & Stream Im acts
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-rnadc'?
h. If discharge is observed. did it reach Water of the Stater (Il' yes, notify DWQ)
c. Ii' discharge is observed, what is the estimated flaw in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............................... .... ........................................................................................................................................
.
Freeboard (inches): 110
5/00
❑ Yes CirNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes �?`No
❑ Yes P 'No
Structure G
Continued on back

Facility Number: — Date (it Inspection
Printed an: 7121120[}0
5. Are -there any immediate threats to the integrity of any of the structures observed? (iel 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 KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
VNo
B. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
( No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Yes
❑ No
_Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type CG 5G 0 Ne�'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application'!
❑ Yes
ON❑
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
XNo
lb. Is there a lack of adequate waste application equipment?
❑ Yes
P(No
Required Records & Dacuments
17, Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
KNo
19.
Does record keeping need improvement? (iel 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
XNo
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?
(iel discharge, freeboard problems, over application)
❑ Yes
,�j No
23.
Did Reviewerllnspector 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
]$f No
IN4.00,10 is •ar- dtflue.neipN -WgftA 00teo- O(Wiog th}s'visit; Y;oji ' ill-t otiye 4ti fpfthoe . .
correspondence: a�OUt. this visit
Comments refer to question # Explain an YES answers and/or an recommendations or an oilier comdn,eT ts.{ .. % °;i' ' '
{ q ): P y y, y 'i a
Use drawings of facility to better explain situations. {use additional.jages as necessary):,;' L'Q'� s
A -a ��-.���t-. Est-. - ��►. Sc t t -t-1,.� e� o C'J(� 9, r s
� � ►`--� � �rz p� �-�� ,�:� � '� � � heed -io �. c�� w►�� `. ICI4k s:
# . ." :r
Reviewer/Inspector NameF:"j...1.I! f• j
'
I Y f! E' x'.FU' H:FF kFS iii i
Reviewer/InspectvrSignature: y� Date: —F-a [ g/

Facility Number. Date of Inspection G Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes O(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29- Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan bells, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes QNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNo
Additional Comments andlorDrawings:
il
CAS-11:401'1 AV
ve-1 `cam ' `
1114 -� llt-'&'\'�--O�—
at
nQ. Gvv..4-d� ���� ►�►�a�-e r����e c� �R -� -i-tie� ��►s
'kiL--- c.J 7Qs
[
5100

, f Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency 691
Type of Visit O Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Af Routine ❑ Complaint Q Follow up Q Emergency Notification D Other ❑ Denied Actress
'Me of Visit: Z� �� Time: I S + Printed on: 7/21/2000
EFacility Number 3I Z 2
Q Not ❑ perational 0 Below Threshold
0 Permitted 0 Certified'' 0 Conditionally Certified C) Registered Date Last Operated or Above Threshold: ..
Farm Name: ark PrAr'per, Fcin+.N Countv:.D.t?,,o..i..............................................................
...............................................................
OwnerName:............ ... ............................................................Phone No:......................................................................................,
Facility Contact:
Title:
PhoneNo: ...................................................
FlailingAddress:......................................................-......................................................................... -....................................................................... ..........................
Onsite Representative:....°!.1r....`.!rF.t?K ....... It Cgr......................................................................
..................................................... r a S
CertifiedOperator: .................... .............................. ............................................................. Operator Certification Number:
Location of Farm. -
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & 11 Longitude �• �6 «
Design Current
Swine Capacity PoDvlation
IN Wean to Feeder
r55
(1"J
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laycr ❑ Dairy
❑ Non -Layer ❑ Nun -Dairy
❑ Other
Total Design Capacity
Total SSL W
Number of Lagoons 1EISubsurface Drains Present ❑ I.agelon Area I0 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
❑ischarr:c5 & Strearn Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes JK No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes No
h. If discharge is ohserved, did it reach Water of the State? (If yes, notify DWQ) [3 Yes VNo
c. II'discharge is ubscrved, what is the estimated flow in galhnin? ►i let
d. Does discharge bypass a lagoon system? (if yes, notify DWC1? ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse irnpacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �R No
Waste. Collection & Treatntent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;5No
Structure I Structurc 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ................... .................................................................................................................................................................................
...................
Frechoard (inches): V7
5100 Continued on back

facility Number: + —q Date of Inspection Printed an: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion, ❑ Yes 'S No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managers through a waste management or
closure plan? ❑ Yes No
(1f 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 maintenancelimprovernent? ❑ Yes fig No
8. Does any part ❑f the waste management system other than waste structures require rnaintenancelimprovement? ❑ Yes g No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings`? ❑ Yes iRr No
Waste Application
10, Are there any buffers that need main tenance/improvement? ❑ Yes Pj No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes M No
12. Crop type Cor, Pi tv a cr F1ve,� Sd &eqh s-,-I.V"rn;Y ►] U.,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes joNo
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 pendcd for a wettable acre delcrinination? ,!� Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes EgNo
16. Is there a lack of adequate waste application equipment`? ❑ Yes J9No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes �@ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ic/ WUP, checklists, design, !naps, etc.) XYes ❑ No
19. Does record keeping need improvement:' (ic/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ff No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design'! ❑ Yes ;gNo
21. Did the facility fail to have a actively certified operator in charge'! ❑ Yes �gNo
22. Fail to notify regional DWQ of emergency siluations as required by General Pcrmit?
(ic/ discharge, freeboard problems, aver application) ❑ Yes ,�] Na
23. Did Reviewer/Irispector fail to discuss review/inspection with on -site representative'! ❑ Yes No
24. Does facility require a follow-up visit by sarne agency'! ❑ Yes P No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 4 No
.. �.. dial. Orjs.or 4fieie► (r re 00(ed 0(wing tjtjs;vjsjt' y0 wild �e4 iy ti fuf tht�
carres�ondenC . ahnntt 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):
14- F5� e.' I,y pen dcd _r,e we4f nLItore de-je,- J.', • I ,,vc de4e.,q+-, done- A�
se,ld Ln,o; cs 2-1 e+r•+•,;.,� }�e� l 'tit'�� S�ww1�� Spr-ti n.-e�s�-G t,1�►1-�e [a+► w� e+�
based yr we.-�es� �rGfc aj�a��r,:n�t-�?ova fe wee b•� �1�3p]ay.+a
.5,4ohe W-1 I CA -D Fx+
W,,"f`''r L./,/,-,;�5 ate., NJG 28 d5
D 6•Ui.1 iq Qor, �es i9il `�Vtpl r ^� t-e,-4r �'cq�� o►� -6 k�'�D w �4tt r'BCa�^� 5.
rill n0 + sea 60V?4 P[ cliecku-cf
j�. iketDnt►"eA,l rowel' keefl;^j Wm y 7,-ee,6DCtrV1 rf_CU►^G
Reviewer/inspector Name 114_ 6 r?�4 11 h94 r 4.' S
Reviewer/Inspector Signature: Date: 5/00

R Facility Number: 3 j -- Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge dllor hplow ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes FNo
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 0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blades), inoperable shutters, etc.) ❑ Yes 0 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �'No
32. Do the flush lanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0 No
Additional Comments antiorDrawings:
Ak
r
5/00

13 Division of Sail and Water Conseirvativn--,Operation-Review
0 Division of Soil and Water Conscri+ation - Compliance Inspection
[ion of Water uality - Cmance Ins p ctianDIY
Other Agency Operation Review
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection e) 24 hr. (hh:mm)
0 Permitted OrCertified ❑ ConditionallyCertified0 Registered 0 Not U erational I Date Last Operated:
Farm Name: ... ..... �r�..k......��'��.......r•eft:!.,............................................ C�unty:.........l. .l �t.�'j................. . ............ .......................
Owner Name:..... ...... .............................................................. Phone No:... ���f{J..�.?��.`..���d.............................,
Facility Contact: .... Wyrijk�.Xj,�4J .................. ..... Title: a Phone No: ...................................................
;Bailing Address:...................................................................................................................................... ......... ............................................... -11.11... .......... I—............
Onsite liepresentutivc:.its'................................................. Intel;ratrrr:.......
.1�....
........................... ............................
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude 0 ` .1 Longitude fig
Design Current Design' Current , Design Current
Swine Capacity Population Poultry Capacity Population Cattle . Capacity Population
Wean to Feeder Z ❑ Layer ❑ Dairy
Feeder to Finish 10 Non -Layer I ❑ Nan -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish 'Fatal Dl sign Capacity
❑Gilts,
❑ Boars "Total SSL W
iNum' ber of.Lagoons 10 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps . - ❑ No Liquid Waste Management System
Discharges & Stream Im set~
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 titan -made'?
b. If discharge is observed, did it reach Water ofthe State'? (Ifycs, notify DWQ)
c. 1f discharge is observed, what is the estimated flow in gal/min'!
d. Doc,; discharge bypass a lagoon systern? (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
identifier:
Freeboard(inches): ........�......................................................................................................................
❑ Yes X No
❑ Yes [X No
❑ Yes Vd No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes go No
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erasion,
seepage, etc.)
3/23/99
❑ Yes X No
Continued on back

F'acilify Number: 3 t — Date of lnspcction
b. Are there structures on -site whicli are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �No
(If any of questions 4-5 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any ofthe structures need maintenance/improvement'?
❑ Yes
0<No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
,kt"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
U(No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�ZrNo
1 1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
[%No
12. Crop type CVS wig
13, Do the receiving crops (iffer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
o
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
Vo
b) Does the facility need a wettable acre determination?
0 Yes
❑ No
c) This facility is pended for a wettable acre determination?
K'Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
;No
lb. Is there a lack of adequate waste application equipment?
❑ Yes
NNo
Reauired Records & Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[(No
r
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Dees record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KINO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
WNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
)KNo
23.
Did Reviewerllnspector 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
I yiQla>�ignjs:ar de#icje.ncte�N were )apteO O rr;ing #hjs;v�s�t; rap will i-eeeiye o fus er
' corres• a de' 'e. ab' ' f this visit.. - • - • - • . . .... .. ... .
Comments (refer to question #): Explain any YES. answers and/or any recommendaiions or: any'other.com'me-nts:
Use.drawings of facility to better explain situations. (use additional pages as n&essary):t
rKFavit is 1� 61� aneeye
Jul' was
�s Lcr�fl5 �� i` ire2IS1 .
u�iC6tlz � S��
V,lk� T �� �ra�K,�'r 11 r�c�-ds �•r
1*z� 9:Ltth� A
04
Reviewer/Inspector Name r 1-Gro �..
Reviewer/Inspector
oh r. C'K�aGoKc pi K r� . rGY : 'r��
e" �.
Date: —�
3123199

Facility Nurnber: • 1 -y2z Date col, lnspectivn
A Odor Issues
25• Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes YNO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? [:]Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon,? ❑ Yes UNo
30. Were any major maintenance problems with Lite ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc,) ❑ Yes 9Vo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J&N,
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Ycs dNu
an ourm ..... an or M raw ng s M �r��e7ai 110, 1, y . MOM �I7-0 1 7!� r q, ! M,{ ,
}�a".,:".�•,l'�"..*'[aai�'x�.:i,�.'�'khii�.t r8!. .. i1' �� 2.y:4t4�617h7.t�^+C��i�': ki��l�i`.':+S"T:i ln�PtlPi�irC�fihF:.'�i.!:��:.i�f:.r +.�..�.
3/23/99
•..+ -..q•r r•-•rye ..r-� r. i .. . � • • .. ... . ':Ti • . - .. . :r;'�R'i•Yr••ry�.rv::'�'S".'!C;.;' -R;►'S'7'y*."'r.��': .. • .. .. ,. 'r..'�:'� � .. .. • .

n,�...ate Conservation Other g n y E2.0
�� Division of Soil and Water .. K
f13
Division of Water Quality
.., - --
Routine 0 Com faint ❑ Follow-up of DW9 ins ection 0 Follow-u of I?SWC review 0 0ther
Date of Inspection
Facility Number 1 Time of Inspection ® 24 hr. (hh:mm}
© Registered Certified ❑ Applied for Permit © Permitted 113 Not Operational I Date Last Operated :
Farm Name: .......... Nlo,r.......A..,-4x. r.... .................. County: r 144 k...................................
Owner Name: [.......»......[....,......L".1.[.......t"6-�.................... I........................... Phone No:..'L.�.i �...�P. :....q�°[.......................................
FacilityContact:.....................................+......................................... rT�itle:.............---,............................................... Phone No:...................................................
Mailing Address:......: P5......i�?a�..�ar, � � �L.k� ...... .I'i;7.1................. .... tic. .. r-tom...............
Dnsite Representative .......... -mw— ............................................................. Integrator: ........ CfAx"115...................... ............ I ......................
Certified Operator :.................................................. ............................................................. Operator Certification Number-, .........................................
Location of Farm:
Latitude Longitude
Design; Current
Swine CapacityPopulation
5U Wean to Feeder
�S5
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population Cattle
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non-Dair
❑ Other
Total Design Capacity
Total SSL W
Number of:Lagoons l Holding Pdnds I0 Subsurface Drains Present ❑ Lagoon Area JE1 SF
❑ No Liquid Waste Management System
eneral
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed From any part of the operation? ❑ Yes No
Discharge: originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If ycs, 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
3. Is there evidence of past discharge from any part of the operation? ❑ Yes i59 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 0 No
S. Does any part of the waste management system (other than lagoons/holding; ponds) require ❑ Yes [PNo
mai mcnancelimprovement?
G. Is facility not in compliance with any applicable setback criteria in effect at the time of design`? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25197

F-aci tT-Number: 31 - Z
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsZolding Ponds, Flush Pits", gte.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier:
Freeboard (ft):............ ta................ ........................... .,.......
10. Is seepage observed from any of the structures?
Structure 4 Structure 5
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 ADnllCation
❑ Yes ® No,
❑ Yes No
Structure 6
❑ Yes ,® No
❑ Yes ® No
P Yes ❑ No
❑ Yes 0 No
14. Is there physical evidence of over application? ❑ Yes V No
(1f in excess of WMP, or runoff entering waters of the State, notify DWQ) y
15. Crop type ............:loll! .[si�rllJv� ......... "USA ..............GO.Y-.Z �........... S4............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? fio Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes WNo
18. Does the receiving crop need improvement? ❑ Yes ®No
19. Is there a lack of available waste application equipment? ❑ Yes I%No
20. Does facility require a follow-up visit by same agency? 10 Yes ❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 19 No
22. Does record keeping need improvement? Yes ❑ No
For Certified or Permitted Facilities ()nlv
23, Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes M No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes tw No
Kj
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes No
[3. No.vintatinns:or. de'ficiencies:wvere hated d6iing this:visit.: You4411 ie'Mve-nQ;furtlier
cvrrespb6debce dhout this: visit::
Comments (refer to uestiun #): ExP- n anyYES:'answers:aniVnr aiiy� recornmendit ons:.or tiny otNier cu n ants.:
L. ..1. E :.:. .. ..: M. J J p,.:» , J •.gj:ervzY ji ; ttSt: .r.. .. .. .�s
Ilse:dit*1ti s of.f:adlit .'.ta'better'ex lain situations.. use addit o:' fial a es.iis nc essu.... }.; s) , »' ; _ �;:=t ° FflifFff!!f?°„eF;F e:
..:.T.!'?iii. i' S iik1E3„ 7si«<3i ��!sE � .i�s..sSP!H.; .. .... ..
l i. Cyr-rR- U++�u� 5 �•�U�� UC a� .E Cavrali's Cone errs tcj ' �
IG. 001ks Ow� in � 46vyL t t S ��Cv t� %K AtO 41. itiL}� (X1(.S 4(-
Zz. W up SIn�UI.[� lae_ � � �n r,e.�,.c.� CVr'v� crap l►�t`�'on . � W��� ��`
ZO ?'1^� V4 �+ cc% t' r
"tloail\ 56JO ' Vmvj �4h}r. tv" �rf a�10r (r Pet swoh
- 7125197
Reviewer[Inspcctor Name i,
Reviewer/Inspector Signature: irjn .. / Date: r

x F'• -
...
n==+ro.=+�«+R.rx�% '...i.---�diiil..ff........ .'...n,.y„.•1;'E[3
Divistnn of Soil and Water onservation ❑ 6ther Agency
Division of Water Quality
F tI
k.
(i •
]• FF
'
,. � ,:..
w»re«fee �...�...........r..-...--•e�.......�1....� �r�f _...r..<..»-,-nw......m�,...w.,.....4ertp-.Now-;,--•.;f°,-a...,,,,,, "`�„•"'"nPPY^:s:,.w;;,.wee w.,.�...yw.-.-m-�.°.,
� F .e€fe
f °.. ` �i �.....
SFY
£ t
€ ?��31 E...._�s�ig.
_ i e
�.�f.
19 Routine 0 Complaint 0 Follow-up (if I)Wi2 inspection o }'ollow•itp or IIswc review 0 Other �
Date of Inspection
Facility Number L'L
Time of Inspection ! tv 24 hr. (hh:mm)
© Registered ® Certified 0 Applied for Permit 0 Permitted 10 Not D erational Date bast Operated:
Farm Name: 1f..C: ........��n����.�t' ....�....�7►'.rm:.............................................................. County, .r....� , rh..........I.r....................................................
Owner Name: ......... !y.'ut✓}Z......6x?.Er........................................................................... Phons Nv: i [ �..ti. .-..'T. Q............
Facility Contact:....... ....�.�q.er............................... Title: ..... d-W.mir........................................... Phone No: q� q. %. -.5� .Q.......
Mailing Address:... � D�.....�O.P.�[lua�....���.�......�........................................ ....A16xr..1b..gnf..... Jgc: .................................. ..� ���1 Y......
Onsite Representative:......... k.k.....�spf................................................................ Integrator:-....... .arylit£.....................................................
Certified Operator,..............Fyn+'........ 4U#fr--.- ............... -...................... -.--... Operator Certification.Number J,,7.b -I.'T
Location of Farm:
Latitude ©'®` 17_-�" Longitude F77210
ucsign
Swine "'' Capacity PopulationPoultry:. Capacity Population. ;'' CAit1e '€ ; € :Capacity 'Populatian,;?r"
Wean to Feeder❑Layer ❑ DaiEX
El Feeder to Finish I0 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean n:. J. . :.;€.k;.:. u=,•
❑ Farrow to Feeder ❑Other
Farrow to Finish 'I'titalDesign Capaciky,
❑ Gilts "" .
❑ Boars f.
tat W � To
,.Number of Lagoons l Holding Pnnds ❑ Subsurface Drains Present ❑ Lagoon Area Spray Field Area J.
itio Liquid Waste Management System ;: ����
e. e
General
1, Are there any buffers that need maintenance/improvement? ❑ Yes 1�31 No
2- Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? [--]Yes ® No
b. If discharge is observed, did it reach Surl'ace Waters? (If yes, notify DWQ) ❑ Yes 91 No
c. If discharge is observed, what is the estimated flow in gal/min.)
A. Does discharge bypass a lagoon system'? (If yes. notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ti No
e4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [Z No
5. Does any part of the waste management system (other than ]agoonslholding ponds) require ❑ Yes 0 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 09 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes Jc1 No
7/25/97 Continued ote hack

J,
Facility Nurnhcr: -31 . —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding Ponds, Flush fits, etc.)
9. Is storage capacity (Freeboard plus storm storage) less than adequate?
Structure l Structure Structure 3 Structure 4
Identifier:
Freeboard (ft): l .L
......7......................
10, Is seepage observed from any of the structures?
Structure 5
❑ Yes ® No
❑ Yes ® No
Structure 6
❑ Yes ® No
11.
is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
IR No
12,
Do any of the structures need maintenancelimproventent?
(9 Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
W,aste,Application
14.
Is there physical evidence of over application?
❑ Yes
D9 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
`
Crop type .........U1.t.ft.. r......Gwr &M"Al .......... f�......µt�>nya.�.................. �?CC ..............G�t 6,11
I
Y1cLirs...........................
16,
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18,
Does the receiving crop need improvement?
❑ Yes
® No
19,
Is there a lack of available waste application equipment?
❑ Yes
[9 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
0 Yes
❑ No
For Certified or Permitted Facilities Qnly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ®No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ® No
No'v1O1 tions•Ur deficiencies. were- noted during this:visit., :You_.'will ireCeive`ho' further
eorresOblidence about this: visit:::
5 .. .. .s� .. ... .. "a
.. :"In:es::::se. ':x: n--'�=�4". . -. .i s..F:.. .: .d:... el,e,ef";i#.
Ggmments' (refeir.tn: question.#i); °->wxplaiu°any: Y �S answers ariillnr, any; recommenclatlnns or any nthie:r"conriments;
�� :.n.
e:3. :s ...�.. ..Y. � s...::,•s:.... .... .' S:l..sd:. -..:i:;.r�.....:.:: ...3133...rsi::. �:. ep���e.i�: :..a 3.
ryd;:: FD+
Use. drawin s of. faciht to better. ex lain sttuatians," use additional' ayes as necessa . : ,..F "'' ;� ? i.
gg
ssE �&4
...
.. .... :Si. '..:.:. .. ... ... a. .. :: .:: .i: eEii°.e: i.:i�. x?l: .:• x
$:':i; u E. ix�..:`:
t l
�L. nruw &K, W-t� 04 14.58C4' 16014 6 molde0 CxhP a 1("gs �'z �� ,7 �C4Z gar{41 S�+nv10 vJ
fcstrdQ�,
'S&Nt . C-NU Y .01 - 164J 6e ��o�a�ra� �� 1rf;��an 14604A 44 4, Zion a
+L �� t-t evjj s x kovj d ke. 14�t by PAI nV Aor~ + Aclj -�UqL .r. ��.iti-�►— i.�s I� ��
rA�r�
t� T
7/25/97
Reviewer/Inspector Name s� S tt
' l€r „F .
w. •�
Reviewer/Inspector Signature: Date: l

Site Requires Immediate Attention:
Facility No. a.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: C.)
Farm Name/Owner: 177991, k d-.4 Wr
Mailing Address:
County:
Integrator: 7 Phone:
On Site Representative: _` ]� Q/L t,L 16AT� .L Phone:
Physical Address/Location:
0 i"
Type of Operation: Swine Poultry Cattle
Design Capacity: 1.1�r1 _ Number of Animals on Site:
DEM Certification. Number: ACE DEM Certification Number: ACNEW
Latitude: ° _o6' 1 Longitude: 27 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: ji� —Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? 9 No Is the cover crop adequate? Yes or No
r
Crop(s) being utilized: 2P A
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Os or No
100 Feet from Wells? I& or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ore
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Slue Line? Yes o6w—
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orb If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
r .
t l S _ G 10, c�A, t p
0 Q Hd_6��
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.