310447_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental W4

Y t( ?
Type of Visit: ,0 Com ce Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up D Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: p Departure Time: 1 P,v County: Region:
Farm name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: �V_ -
Certification Number:
Longitude:
design Current Design Curren#
Swine Capacity Pop. Wet Poultry Capaclty Pop.
Wean to Finish Layer
We.awto Feeder 11 INon-Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
eider to Finish
Farrow to Wean
Farrow to Feeder
Design Current
❑ • P,nuit . Ca acI Pop.
Layers
Dairy Heifer
❑ Cow
Non -Dairy
Farrow to Finish
Gilts
Beef Stocker
Non-Laye
I
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Othe
ether
Turke s
urkey Poults
Other
Discharues and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Qther:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes VNo ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑Yes No ❑NA ❑NE
[:)Yes ❑ ❑ NA ❑ NE
❑ Yes o [] NA ❑ NE
❑ Yes 21No ❑ NA ❑ NE
Page 1 of 21412015 Continued

Facilit Number: E(7 Date of Inspection: 3
1�ftte 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?
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5 v
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ 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
Info
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CNo
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
�f;
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesrN❑
NA
❑ NE
the appropriate box,
❑ WUP ❑Checklists DDesign ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
d No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
n 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
❑
❑ NA
❑ NE
23. If selected, did the facility fail to instalI and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - jDate of Inspection: 12 4I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q'lro ' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Rio—❑ 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 structures) 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 0 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 E No ❑ NA ❑ N E
❑ Yes ONo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes ENo
❑ Yes [3 N
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Carttiments (refer; to'ryuestiun.#]; Ei[plAiriany,.YES.,unswers?antllor� any�aildltiniial, recommendations W-0k,
.:.S' �.Y, .,pr� �•.�.r.�a,.s,❑se drawl ea:nf^facilitv,to het#er ex iain;sttiiWons;(use'addltional na�es.as,necessairvl:' '>� ' s E is :�
Reviewer/Inspector Name: I / ct ` C � Phone:
ex --
Reviewer/Inspector Signature: Date: I �,
Page 3 of 3 214,12015

Type of Visit: aColiance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine ❑ Complaint Q Follow-up Q Referral ❑ Emergency Q Other Q Denied Access
Date of Visit: j Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
W 'an to Feeder
eeder to Finish
Design Current
Capacity Pop.
7-40
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle CWpacity Pap.
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. l;oul# Ca acit P,d
Non -Dairy
Farrow to Finish
Layers
Beef Stacker
Gilts
Non -Layers
Beef Feeder
boars
Other
Other
Pullets
Turkeys
TurkeyPoults
Other
Beef Brood Cow
Dischar es 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? (it'yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes fo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
2-No
❑ NA
❑ NE
[—]Yes
No
❑ NA
❑ NiE
Page 1 oj'3 21412015 Continuer!

Facili Number: ] - T-( Date of ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier: t 2..
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5 "
Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
rJ '•" ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes [3-5a ❑ NA [] NE
❑ Yes No [] NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E:fNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes E31'Zio— ❑ NA [] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes No ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 12<0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Froxen 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
ET -No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑<Io
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3 No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
ENo
[3 NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Ef No
[] NA
[] NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3-qo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
ETN o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. E Yes ❑ No ❑ NA ❑ NE
[ 'Vaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
0No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
Page 2 of 3 21412015 Continued

t
Facility Number: - [Date —of Inspection: 4 t
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes ❑3-no
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C;�No
the appropriate box(es) below. T
❑ 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:
DNA ❑NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Q'5o_
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
EE 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? ❑ Yes [allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EJNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes �fNo ❑ 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)..
[:]Yes ❑-N-o ❑ NA ❑ NE
❑ Yes 21"K-o D NA ❑ NE
❑ Yes 0--No ❑ NA ❑ NE
❑ Yes En'No ❑ NA ❑ NE
S Q o
tn S c rti ij S r " P'+r► l r'`` A—s r, r
Vf""j 1 Sgo^ e.l^ bw4- frt 14AVA1��zod6 c..tw�. �3 ...tidt w,r'' 3Po fI�N�01-CGS;
f C�It f( 9Q`{� oG-c.r + kC tee— c- 7. 0n��{CI�r
Z,t'r ti 7 one t S& & r�. a� c�� r
P�f..r4;,F�I,r
S G p o'- r ., ' �ac� e k 4-
ReviewerllnspectorName: �eA, ( C+ ^� (�
Reviewer/Inspector Signature:.---
Page 3 of 3
. 1.,
Phone: ct (0 7 6 7 A f
Date:
21412014

(Type of Visit: UC Hance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: f 9 v0 Departure Time: [pin County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
s4Y'e-
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Curren_ t
Design Current
Swine 11111
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
aily Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
1 iI 0
' ZQ o
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr Poultr
Ca acit
1?0
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Turkeys
Othe
urkey Poults
Other
FTOthcr
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 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 I❑'Ko ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
]Yes
�o ❑NA ❑NE
❑ Yes Fj"No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - 97 Date of Inspection: di 22 /
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes arqo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:Spillway?.
Designed Freeboard (in): 1 2-
Observed Freeboard (in): 3 K 54
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EJIN o ❑ 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 E5<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 02'�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [D<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives (hat need ❑ Yes [io ❑ NA ❑ NE
maintenance or improvement? 11. is there evidence of incorrect nd application? If yes, check the appropriate box below. - Yes ! ❑ NA ❑ NE
❑ Excessive Ponding M 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 [rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes TNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
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? lfyes, check
the appropriate box.
❑ W UP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
L3` Io
❑ NA
❑ NE
❑ YesFr-No
❑ NA
❑ NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
5--No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [T'N"o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" RainfaiI Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo
N❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE
Page 2 of3 21412015 Continued

Facili Number: 3Ljq 7 Date of Inspection, z
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
❑ Yes
[ 9-o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
["No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
[]$o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[�rN o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Zf No
❑ NA
❑ NE
33, Did the Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
rNo
❑ NA
❑ NE
Cornments (refer to.question #]: Explain any YES Answers And/or any :additional neornmend6tiuns or'nny{otber: cdtntnents:�. '�,s."-
tyUse drawings of faeiliu better explain' situations(use additiarial.pnges.as;necessarY)"F
{� 09 sk re 44- -4 lea h7r,9 f rp " " (j . A.-f 'W, 30 4•r v 5 .
AQ f ty
Cv j fie �v aj_s a � �� d,,Iv n ri,.`l 1 yCto/k arc-, r4o preFc'-i A. -AA 09
a
'22� �[Z,� Tkl A e_ �Ipd� Va.no� Kr�ty t(r.e ' [ Xt:k
1'A4! r
r
Reviewer/] nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 77 G T3oy
Date: G z
21412014 V1

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 011outine Q Complaint 0 Follow-up Q Referral Q Emergency 4 Other 0 Denied Access
Date of Visit: 1 Arrival Time: j Departure Time: County:
Farm Name: 1Ljf Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: S�"
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region: Lj_l�
Design Current
Design
Current
Design Current
Swine Capacity
Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D P,ouItr
Ca aci
I'o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
113cef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Disehage s 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 2TNo ❑ NA ❑ NE
❑ Yes ZfNo
[:]Yes J Vo
❑ Yes OrNa
❑ Yes ENO
❑ Yes f!!fNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili ;Number: 3 1 - Date of Inspection: 2.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a, If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
'Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
— -;
Observed Freeboard (in): X62-
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
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
[] NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
[DNA
❑ 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
Rare Soil
[] Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes [] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility. Number: 2S- Date of inspection:
34. Did the facility fail to calibrate waste application equipment as required by the perrni ? ❑ Yes Q No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 12'ICTo
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 ,�Io
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P3—Na
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)
3I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes .2fi10 ❑ NA ❑ NE
❑ Yes J;3"Mo ❑ NA ❑ NE
❑ Yes ;2-No ❑ NA ❑ NE
❑ Yes JD -No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes kno ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or any other comments.
use drawings of facility to better explain situations (use additional paces as necessary).
�4011�e /' /v
4- 1C1e1eS(7ccP1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Z
//y
141? W1

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q Routine Q Complaint Q Follow-up Q Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timc: eparture Time: County: Region: = =t-`�
Farm Name: _k32(4 1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:YXlr�l
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Design Gurrent
CQrkflclty. Pop.
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Q . l'oult .
Ga aci
Po
Non-Daity
Farrow to Finish
L
113eef Stocker
Gilts
Boars
tither
Other
Non -Lavers..
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
Bees Broad Caw
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D 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 )E17Tio ❑ NA ❑ N E
❑ Yes -'ffNa ❑ NA ❑ NE
❑ Yes Eno ❑ NA ❑ NE
❑ Yes �no ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
ElYes gNo ❑ NA ❑ NE
Page 1 of 3 14 21412011 Continued

Facility Number: IDate of Inspection:CaAaT
aste 611ection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P3'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): r)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes No ❑ NA ❑ NE
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 answerer/ 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
Feno
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Z No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑,Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
�► E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable t
❑ Yes
�Pi0o
[] NA
❑ NE
acres determination?
e
17. Does the facility lack adequate acreage for land application?
❑ Yes
PTNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
02 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J20No
❑ NA
❑ NE
the appropriate box,
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Eno
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ RainfaIl ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes k] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Confinued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes zr ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes g No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ;no ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes eNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA �? NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ;3AE
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 g3'0'No ❑ NA ❑ NE
permit? (i,c., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [;�&E
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ;�oNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? ❑ Yes )'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes P3'fVo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. 7-7
Use drawings of facility to better explain situations (use additional pages as necessary).
5I q113
3 / -7/1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �6
Date:
Z14 20 1!

Type of Visit „Q'Eompllance Inspection ❑ Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Vls' Routine ❑ Complaint ❑ Follow up ❑ Referral ❑ Emergency Q Other ❑ Denied Access
Date of Visit: ivai Time: 11.2 /3 arture Time: County J Region:-&
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ I = " Longitude: ❑ 0 0 ` = "
Design Current Design Current Design Eurrentiiiiii
Swine Capacity Population Wet Poultry Eapaclty Population Cattle Capaeity Population
❑ Wean to Finish
=11OLayer
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
I
Dry Poultry
❑ Layers
❑ Non -Layers
Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stacker
El Beef Feeder
❑ Beef Brood Cow
Number of Structures:
❑ Gilts
❑ Boars
El Pullets
Other
❑ Other
❑ Turke s
❑Turkey Puuets
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes .0No ❑ NA ❑ NE
[I Yes El No
El NA
El NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes Z&
❑ Yes 1] No
❑ NA
❑ NE
❑ Yes f No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Ifacilt Number: IDate of Inspection: /
Waste Collection & Treatment
4. IVtorage•capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identi Fier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z No ❑ NA ❑ NE
(i,e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ONo ❑ NA [] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;2rNo [DNA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes �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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Repuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes , No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes Z'No
❑ NA ❑ NE
❑ Yes j;3'No
❑ Yes �no
❑ Yes ZI No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ED-go ❑ 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 Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ' No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: >aate of Ins action:
24. Did the facility fail to calibrate waste application equipment as required by the perm' ❑Yes
No [DNA ❑ 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 to provide documentation of an actively certified operator in charge? [—]Yes PNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes XNo ❑ 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 duality concern? ❑ Yes ONo ❑ 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 RfNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
ZNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X,No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
,No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question.#): Explain any. Y)ES answers and/or any additional recommendatioris or any.;othee c'ommentffi diµ;
Use drawings.of facility to better ex lain situaiiorEs (use additional. ales as necessary}, h :•�.,.;., =.7`p; e r ±:t ;�' i ce ?;_
ru'U3 ti j t z�� Ay
o a
fe L D f-JS
l 60
I b 1 J L i 1, -7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 'ZE LK
Date: 3
&:;�
4/ZU1

e 10-Division of Water Quality
Fatuity Number 0 Division of Sell and Water Conservation
Q Other Agency
Type of Visit P�Co`mpliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit Oil6utine O Complaint O Follow up O Referral O Emergency ❑ Other ❑ Denied Access
Date of Visit: � Arrival Time: 7r' ❑ 0 Departure Time: County:
Farm Name: 44Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: wr
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Form -
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back -up Certification Number:
Region: I -
Latitude: = e ❑ I =11 Longitude: ❑ o = 6 ❑ 15
Design f Current Design Current
Capacity Population Wet Poultry Capacity Population
.I. j ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
9
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 �o ❑ NA ❑ NE
❑Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
2No
❑ Yes ,ErNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Jallo ❑ NA Cl NE
a. if yes, is waste level into the structural freeboard? ❑ Yes 71No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
LO
5. Are there any immediate threats to the integrity of any oCthe structures observed'? ❑ Yes Po ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes FNo ❑ 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 [;?�o ❑ NA ❑ NE
R. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes jNo ❑ 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 []?Ro ❑ NA El NE
maintenance or improvement? /
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement? XNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes ❑NA ElNE
ElExcessive Ponding ❑ Hydraulic Overload ElFrozen Ground [IHeavy 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
itilo
El NA
❑ NE
15. Does the receiving crop anchor land application site need improvement'?
❑ Yes
I
Io
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers;andlor airy,'recummendations.or?any:ather,'camments.:
Use drawings of facility to better explain sitttatinns. {use itdditional pages'as necessary}:.
LR'eVv'i'ewcr/Jnspector
wer/Inspector Name
—
i ,y„,�: ,, ,�:A. Phone:
Signature: Date: 3
1 /2XMJ Continued

FacilityNumber: W — Date of Inspection
Required Records &_Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ff No ❑ NA [IN I-
20. Does the facility fail to have all components of the CA W MP readily available? If yes, check ❑ Yes ;?rN 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 ,FNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XNoElNA ElNE
24, Did the facility fail to calibrate waste application equipment as required by the permit`? ❑ Yes �o El NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes �o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ ElNA ❑ NE
Other issues r
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes
o ❑ 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 duality concern? ❑ Yes �<co ❑ 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 PI'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? El Yes 4o ❑ NA El NE
33. Does facility require a follow-up visit by same agency? ❑ Yes;!rNo ❑ NT ❑ NE
AdditI' r'i 'Crfmmerita: analur; Drawing"°
SI�I oQ' S�Gjl� jZyjrt e,s
/W/-- 6reto6 ielma'e't #(f lAr
ll/l r° 1.3 / /1etv _sum oL i�' %%
10 e3 3 if sfrl% 4 t5h ,v/C5C rU6►n114
d o Og
,�Ir.� Sal ray S. G
�r �v 2,3 j 2r4/4 r, aon�
�l a CGarIC�� S%d
Prrge 3 q f 3 I2/28/04

Type of Visit 0 Compliance Inspection D Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q"Routine Q Complaint Q Fallow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: aJ Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: =41(L
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator: _ �AX�?
Operator Certification Number -
Back -up Certification Number:
Region: 1G?
Location of Farm: Latitude: = o = I 0 11 Longitude: 0 ° = 1 = «
Design Current
Resign Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Laver
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other EllNumber
of Structures:
Discharees & 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?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes �;Ko ❑ NA ❑ NE
Structut l Structure 2 Structure 3 Stnicture 4 Structure 5 Structure 6
Identifier: / 2_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity orany of the structures observed? ❑ Yes Eno
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑
❑ 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 XNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes f �io
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) J
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ 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"
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1;190
❑ 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
tNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
1N❑
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
:. :. .r xi!i..-.....: k'�.F:t.i.t.(.J.�...:� n6
t6i"ents. (refer to•:question`i6 "Explain. any. YES. answers. an, any recommen.datlons n.r,.,any-ather. commen(s.
ilsc`draw ings of facility to better explain situations. use additional pages.as;necessary)::^ ..• .:-,.3,.�=.' :� ; _ :;`� ,: ,.
I Reviewerllns eetor Name Q
jJ P Y1 : Rhone:
Reviewer/inspector Signature: Date: 3473 �o
r
Continued

Facility Number: — Date of Inspection 3
Reaulred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�No ❑ NA ❑ NE
❑ ❑ Design ❑Maps ❑ ether
the appropriate box. WUP ❑ Checklists I
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the pen -nit?
❑ Yes
?_�o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑'1Vo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes PNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑ Yes
N
❑ NA
El NE
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
P
33. Does facility require a follow-up visit by same agency?
El
❑ NA
❑ NE
Ai4//'W 0. 7 /
4 lE 0�, Set
12128104

0
Type of Visit QVRou
lance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visitline OComplaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
rrivai Time:
parture Time: County:
Facility Contact: r, Title:
Onsite Representative:
6z_'n��
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
/i 444
Phone No:
Integrator' /{• ' Tom_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = s = « Longitude: = e = 1 0 14
Design Eurrent
Design Current
Design
Current
Swine Capacity Pnpulatinn
Wet Poultry Capacity Population
Cattle
Capacity
Population
❑ Wean to Finish
❑ Layer
I I
❑ Daia Cow
❑ Wean to Feeder 1 10 Non -Layer I I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Cilts
ElNon-Layers
❑Beef Feeder
F Boars
El Pullets
❑ Beef Brood Cow
❑ Turke s
ot e
❑ Other
10Turke Puults
❑ Other
ENNumblerloti"StruNctureRs:
❑ischaraes & 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
VNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

S
Facility Number: — Date of Inspection
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 10 No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes allo ❑ NA ❑ NE
❑ Yes Vj 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 � I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes allo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9, Does any part of the waste management system other than the waste structures require ❑Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2fN❑ ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes.LJ
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElILJ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
I.C.J No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
C4mmQnts (refer to question #):.ixpiain any YF:S answers astdlor any recommendations orany other comments.
Use drawings-af facillty tabetter ex`plaln.situatians. {use additional pages as necessary);
'
T
.: -...-,:..-.y -i ..T Phone:
ReviewerlInspector Name Zr
Reviewer/Inspector Signature: Date:'
M.-
Page 2 of 3 12128104 Continued

Facility Number: -- hate of Inspection
Renuired Reeords & Docuinenls
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
❑ Yes PNI"O ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑'No
❑ Yes �lo
❑ NA ❑ NE
El NA ❑NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 124 Minute Inspections ❑ Monthly and I "
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ No
❑ NA'
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ON.
❑ 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
yr.o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
VfNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V No
❑ NA
❑ NE
UtherIssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
34. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
710
ElNA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Ala
3// t,151 �.7zee:,�
1
A.
Jj
12J28104

Division of Water. Quality.
Facility Number C Q Division of Soil and Water Conservation. '
d Other Agency 4
Type of Visit gCompliance Inspection D Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine ❑ Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit; q t $ p"] Arrival Time: ❑ t) d Departure Time: County: bwPLXnJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: srcwc- G P-,qb y
Certified Operator -
Back -up Operator;
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0` 0" Longitude: = o= 6=
46
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
I 17-q6
I 17.4b
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Imnacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design . Current . .
Capacity Population:
❑
Dairy Cow
El
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
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? (I ryes, 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?
El Yes 2/No ❑NA El NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ElNA
❑ NE
❑ Yes
❑ Yes
LJ No ❑ NA
❑ NE
❑ Yes Ld No ❑ NA ❑ NE
12/28104 Continued

Facility Number: 31 — `14 1 Date of Inspection
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Cj 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: (0Gv61J 1 L466) L
Spillway?:
Designed Freeboard (in): 11 , a Z.
Observed Freeboard (in): 7 g 3 7
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 ENo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes [2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes ]�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[_ No
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ld No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IQ No
Cl 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):'
4 j A WE ST6 C*-WG f,'AM.
��►r) dk"94#17 61l444 VA/ &e4l'SW4, AIEEo LoPVr 6f 64LWA7ZWJ AkU 6.1c.
qV
Reviewer/inspector Name f Phone:Q%ff - 7f
Reviewer/inspector Signature: Date: q p
Pace 2 of 3 12/2 V#4 Continued

r
Facility Number: 3YL11 Date of Inspection �1 J
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
❑ Yes �No ❑ NA ❑ NE
❑ Yes D<o ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [I Waste Analysis El Soil Analysis El Waste Transfers
El Annual Certification
El Rainfall rl 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
[T] N
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
L=1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
6"Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
eo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
D A
❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
04o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Lr 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
Q 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
2 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
El
��
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
Lr N
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency`?
El Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

s;
ElFaciliq-Number
Division'of Water. Quality
Q Division of. Soil. and 'Water Conservation`:.:
0 Other Agency
Type of Visit ef Co Nance Inspection Q Operation Review Q Structure Evaluation D Technical Assistance
Reason for Visit Routine 0 Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: 18 J Arrival Time: ® Departure Time: County: '0P4P4T Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: _ �L �� rA I,,jL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 00 =1 = 14 Longitude: =o =1 = «
Design
s. gn Current Design ?Current.. _ ?"It D sign•
a �: ur'
Swine. Capacity Population Wet Poultry. Cu aCi Pis ulatiaa Cattle.,
ri' IPo' ulatioti'.
p y p ... p ty p
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder 10 Non -Layer
® Feeder to Finish d
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ farrow to Finish f
❑ Gilts
❑ Boars
Other
tither i
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Daity Cow
❑
Dairy Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
r
Number of;.5tructures:: 'EJ
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
Cl Yes /No❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
El NE
❑ Yes
❑ Yes
LJZoEl NA
ElNF
El Yes
❑ NA
❑ NE
12128104 Continued

Y
Facility Number: — {- Date of Inspection >S 0
Y
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier: 09r,02,-1 t eA (I --A
Spillway?:
Designed Freeboard (in): 1 PI,
Observed Freeboard (in): 3 ,j 7r
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ZrX10 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 7NOo
❑ NA ElNE
❑ Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7N(j
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA [3NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 ibs [:]Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (B (0 S G-16 V4 D to C-r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Ef*No ❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
dlNo ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any at her.; comments::.
.Use drawings of facility.to better explain situations. (use additional pages,.as necessary):.:.
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Page 2 of 3
I PhoneL O r1 �—
Date: r� j6 a6
12128104 Continued

ti
;' �lu ac[1lty tYumher: - y� Date of Inspection a a
Ke
ruirrd Recordg & Documenfs
19,
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
0< ❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps [:]Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2 No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L' I N El NA
[3 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
LI No ❑ NA
❑ NE
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
El Yes
ONo
El NA
El NE
❑ Yes
PrN'o
❑ NA
❑ NE
❑ Yes
'f! No
❑ N
El NE
[]Yes
[:]No
��NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal'?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Cnmments and/or Drawings:
❑ Yes Gi'No ❑ NA ❑ NE
❑Yes [:3, o ❑NA ❑NE
❑ Yes E'No ❑ NA ❑ NE
❑ Yes <o ❑ NA ❑ NE
❑ Yes 3"NNo ❑ NA ❑ NE
❑ Yes L'J No ❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit 9f Compliance inspection 0 Operatlon Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit i6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access {I
Date of Visit: Arrival Time: Departure Timc: County:
Farm Name: V� Owner Email:
r r
Owner Name: Gzdff _ A I(� Phonf:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: L-e e' I ` Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region: &�4&
Latitude: = c [-7 6 0 64 Longitude: = o = 4 = 61
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
_ �� ❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
UTurkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
b. Did the discharge reach waters of the State? (If -yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ®`
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
12128104 Continued

Facility Number:, / -- Date of inspection LI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. li'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: *�l hl'
Spillway?: Alo _&a
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 ❑ 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 DW4
T. Do any of the structures need maintenance or improvement? ❑ Yes XNo ❑ NA ❑ NE
8. 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)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? I
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes toNo ❑ 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 [I Evidence of Wind Drifl El Application
�, Outside off Area
12. Crop type ,
s} �IFiQ/!')�1U�i � AZT I �•�• f �V ��F � . 5 . /�'! 4�L65 T 6AZ;-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes XTo
[I NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes ZNo
❑ NA
❑ NE
R15;r Aa49'e7, e-0
5 757,j lee-).
Reviewer/inspector Name
Reviewer/Inspector Signature:
Phone:
Date:
12128104
r�
0
Continued

Y y 7
Facility Number: :61Date of Inspection ►I
Required Records &_Documents
19. Did the facility fail to have Certificate orCoverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WI1}' 0 Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes /Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
I/No
❑ NA
❑ NG
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
X,No
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
/NA
El NE
Other issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
fi�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the dine 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
gNo
ElNA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
A No
ElNA
ElNE
33.
Does facility require a fallow -up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawfngs:
� wz7
e
P
I et
Gear 0 ,
7
Ae
12,128104

Type of Visit oCompliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit �noutine Q Complaint D Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of visit: Time:
O Not Operational O Below Threshold
© Permitted © Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
0. Farm Name: ...U.vele ...3. 41A.J.k......Sr.......�sc-r '-_� ................. County:. tx(-Ph I.... ........... .. ... ..... ..... ..................
OwnerName:........................................................................................................................... Phone No:.....................................................................................
MailingAddress:.................................................................................._.................................................... ...... ......... .............................. ».................. ..........................
FacilityContact:............................................................................. Title:................................................................ Phone No:.....................................
Onsite Representative: d Integrator: T Y r
Certified Operator:
Location of Farm:
............................................................. Operator Certification Number:..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' �«
{ ; Design'.: 'j3' Curl ent' ;� ; {E +' " "+ 'Design _ p Current' : Design. ,: ° Current.; '
Swine k-. ' Ca aci : Po `inlationi I; 1?gultry .;i1.4,.'-Ca aci Po iulation. F•+ICattle .!Capacity.'Pu ulatiop s;
❑ Wean to Feeder ; ❑ Layer ❑ Dairy
eeder to Finish ❑ Non -Layer `. ❑ Non -Dairy
Farrow to Wean � � ;, i � _, •.;f .' , ,..:
❑ Farrow to Feeder ❑Otherxi, Y
Farrow to Finish "r
-, ;' „(rv' Taia1 Design Capacity; '
❑ Gilts "ri :i '' ;, ,ti i
Boars ; ..�" ; _ `<€ "i k t Total: S5L W .
Trans'
Discharges & Stream Iniyacts
1. Is any discharge observed from any part of the operation? ❑ Yes i� lra
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? {If yes, notify DWQ} ❑ Yes ❑ No
c, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �ZNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes rNo
Structure. ] Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: '
Freeboard (inches): I
12112103 Continued

Facility Number-:j Date of Inspection
5. A're there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aaplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop hype ` 15 e> f v► it Ac-�. ( H ❑ A-, ] , --, r n -A
13. Do the receiving crops differ with those designated in the Certified
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?
Waste Management Plan (CAWMP)?
Odor Usues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes ;rNo
❑ Yes .2r�o
❑ Yes PAO
❑ Yes EITVo
❑ Yes 214o
❑ Yes PNo
❑ Yes j2 No
❑ Yes ;Rf4o
❑ Yes 12 No
❑ Yes 2 No
❑ Yes 2 No
❑ Yes ❑'Flo
❑ Yes Q'5o
❑ Yes eNo
❑ Yes .fNo
❑ Yes C3'flo
❑ Yes OI40
1 �1.111 r:st• .fin �.. n••� s...��.ux.n • , .. .•" it --i. • :;r: •r.:a au:s,n::. •:=s:�:, - :u.z- ::� •� « sr;:.., s
C46 ehts'{refer,to questegn'#):�Eaplairt'Any., ans►versa:andlar arty;recumrnendations'nr sn ,ntl*er; camm�ents. ;: ; . i' ' €' '
X0 �
:rq=-tlr':r:;il;��u:!:er... -��;: .+I.� .�a,• «rw3��rs::� �€., ��b..,�+. €t�-,. ..n: 'r.. raR:: y:�€;s�:3s:::r-+::: x��.S. ,f � �..T.- ,.._:r�«..�., ,.rr
11Se dr8w1A ! �;
gs facilityito.better exglain sltuafioras {trsaadditianiil pages as necessary)s Field Co Final Notes
I.' .:.:,rs "i i"s " ..: w F;:' € :: Yl•. }i ;:. ,. i:: ;y ^}; ffx.::+ a+ �t
s i?„ .�s,:;:raw ,.«.d{ a �lry' a,r+.iti;k.�i�...1�u�';;°si'K��'�•o-.yK+lna` :lt +�7if�l r �. Il{s,c�+`�'+i 1•"�..iF'i'
,i•H`x�+j?i:'sn.t 4i1. I�N!�:.;L-'yV�
A.
-7) VleQse, )4ep Lo e4d ot o Y% 0 'L�� d e, C) I V-4., rn CW 2
d 0 LZ V-" -Moni4t(- oci,_O, 0,
'Re C
Reviewer/Inspector Name s : �,: ;� : ¢ `. h Y!E
. ...�xk..aa:....:7•v. j,a, e:.:°- z ",i F:.:$.a 1:.. _.f�
Reviewer/Inspector Signature: Date: r
72/12/0-3 f nartrar►rd

Facility Number: '3 1 — Date of Inspection
Reuuired Records & DocumenL,;
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes 040
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(iel WiiP, checklists, design, maps, etc.)
❑
P?'NO
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�la
❑ 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
INo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Oko
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[l o
(iel discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Q*o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
❑'�Io
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
eNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes V(No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ AnnuaI Certification Form
12112103

Di�ki n" Quality
+ r� :- o of Water } :r
•F:.i'..„n s'
yF °w:i r;? *. i:;' + ; DiFisiutl"of.Soil and Water Conse6ation f a
S
Oat
�;�•• �.;-;. 0, . .�, •� '; ,',- . �., •_%�;
)1z�y ={ A ~
i i'
h; rrc
..r�:.sirr$.;,,F'];��?1.W d6�-•i+..:... •.�:.. c'.i.,G>:i
n r '
Type of Visit & Compliance Inspection a operation Review Q Lagoon Evaluation
Reason for Visit 6 Routine OComplaint Q Fallow up Q Emergency Notification Q Other © Denied Access
Facility Number Daft- of Visit: 1 g d Tiini- Printed on: 7/2112000
NNot O eration. Q Below Threshold
.Permitted [I Cerrtiified 0 Conditionally Certified [3Registered Date Last Operated or Above Threshold : .........................
Farm Name: CJl'�P� kCounty:............ �k,/..�!*.....................................................
..... .. .............................................
Owner Name: ..........
................................................................... Phone No:...................,...........................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: 4 Integrator: �.frY�►r -jisJiAe
Certified Operator; ......... ___ ................................................................................................. Operator Certification Number:..............
Location'of Farm-
[3 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 66 Longitude �' �4 69
Destin Current
Design Current
Design C6rirent
5 : Ca ci Population
Poultry Ca act Po ulation Cattle Ca _ -eft" .: moo' utatiun
Wean to Feeder
Layer Dairy
Feeder to Finish
❑ Nan -Layer ❑ Non -Dairy
'Ps �
Farrow to Wean
��.
Farrow to Feeder
❑Other
Farrow to Finish
Total Design Capacity
[
Gilts
CCI;�i
Boars
Total SSLW"
r
Nuiott " r;ai lagoos:33:;; _.
❑ Subsurface Drains Present ❑ Lag^on Area
Spray Field Area
Pod Tiraps. ❑ No Liquid Waste Management System
x• -' }�
Discharees & Stream Im acks
1. Is any discharge observed from any part of the operation? ❑ Yes [K No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of [lie State'? (If yes., notify DWQ) ❑ Yes ❑ No
c, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) []Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes C'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [9 No
Waste Collection & 'rreatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes In No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
1~recboard (inches): Izq"
5100
............................ ...................................
Continued on back

Facility Number:Date of Inspection bZ
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes ONO
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 maintenance/improvement? ❑ Yes [XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® 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 MNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettabie acre determination? ❑ Yes 91 INU
c) This facility is pended for a wettable acre determination? ❑ Yes ELNo
15.
Does the receiving crop need improvement?
❑ Yes
§l'o
16.
Is there a lack of adequate waste application equipment?
❑ Yes
%No
Reauired Records & Documents
17.
FaiI 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?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
M No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
fB.NO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IN No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[allo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
V9 No
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
®,NO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ENO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes.
® No
ao �g#c�ejtl<iFi Vvre 1`E4 {��S'►+�s�t; Yoj�tle�ifc �a#'t�$ . .
;corrt~s denr� abou
�r,4, � �t�erwa rl� "►G� �'Or7C� .51Uc'1 �.- • �-.r...n. ��Il /s-�-i► �:�r �� �.
'1' �oReviewerllnspector Name
_#t
Reviewer/Inspector Signature: Date: %j PZ sroo

Facility Number: — Date of, Inspection QZ Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ® 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 E9 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)
23. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 9No
30. Were any major maintenance problems with the ventilation fan(s) noted? Ox. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ENo
32. ❑o the flush tanks lack a submerged fill pipe or a permanentltemporary cover? ❑ Yes &No
Additional . ommen and/orDrawings:
5/00

Facility Number [late of'�'isit, - � (70 ']'line: . Q � Printed on: 7/21/2000
Not Operational 0 Below Threshold
Permitted [3 Certified 0 Conditionally Certified E3 Registered Date [cast Operated or Above Threshold: ............ :............
1
i+arin Name: ...... o...�.q.5,.:�...... &A.. ..,.Sy....... ..lrr 1. County:..........................................................
OwnerName: .....0.}. .........................1�.............................................. Phone Nn:.......................................................................................
FacilityContact:...............................................................................Title:................................................................ Phone No:...................................................
MailingAddress: .......... ....... ........................................ ...... .................................................. ......................................1...................................................
Dnsite Representative.... ..................................................................... - ................................. Integrator:...LA..I,R.IA4......-..111
CertifiedOperator:.....9.1.}�cx........... 11— ... ......... -`. ....... Via............ Operator Certification Number:
Location of Farm:
rq
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' Longitude •
Swine
Design Current Design Current
Capacity population Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Feeder
If Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
❑ DtYicr
Total Design Capacity
Total SSLW
Number of Lagoons ❑Subsurface Drains Present JJEJ Lag -on Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System .
❑ischarges & Stream Im act5
1. Is any discharge observed from any part of the operation'?
❑ Yes 00
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Dther
a. II di wharge is observed, was the convcyancC 111i111-TINI(le?
❑ Yes
J�(No
1). If discharge iti observed. did it reach Water of the State'? (If yes, notify DWQ)
❑ Yes
f�ifiio
c. II'dischar-u is observed, what is the cstiltUticd flow in gal/min:'
d. Does discharge bypass a lagntm system'' (ll'ycs, notify DWQ)
❑ Yes
XNo
2. Is there evidence of past discharge From any part of the operation?
❑ Yes
;00
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
5No
Waste Collection & Treatment
4, is storage capacity (I'reeboard plus storm storage) less than adequate`? ❑ Spillway
❑ Yes
No
x
Strucir e I b+AStruclurc 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier. ...............................5.Q..
Freeboard (inches): -
5I00
Continued on buck

Facility Number: 31 — Date of luspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures Observed? (ie/ trees, severe erosion,
0 Yes
[ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure'plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenance/improvement?
❑Yes
No
8. Does any pan of the waste management system other than waste structures require trtaintenance/improvement?
❑ Yes
No
,
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste ApElication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11, Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Pian (CAWMP)?
❑ Yes
kNo
14. a) Does the facility lack adequate acreage for land application`?
❑ Yes
s}
b) Does the facility need a wettable acre determination?
❑ Yes
fl(No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
[ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Renuired 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, maps, etc,)
❑ Yes
No
19,
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[ No
20.
Is facility not in compliance with any applicable selhack criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
WNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over appl ication)
[I Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certifies! AWMP?
❑ Yes
No
1IO yiaidns.o�- �1 E�CfiCiCS ►i CE' I1QtCd iiitring #hj5,viE5ltt Your ill-,ee�iv ijti fu>�t r
re resp6iideiic'e'abiyu7t.t'1LS.Vislf.'.'.'.'. .'. .'.'.'.'.'.'.".'.'. .'.'.'.'.'.'.'.'.".".'. .'.
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):
R(• rtlAs ho,.s �e 14L 414 r;L we -"le- &,ax L.
Tr
� rm [dales jcddl w�.tal
I&
Reviewer/Inspector Name Al 4A
Reviewer/Inspector Signature: p ,Z�� _ Date: // . v a SI�a

Facility Number: — Date of Inspection - -Q D Printed on: 7/21/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor hplow ❑ Yes 4 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 q'NO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan hlade(s), inoperable shutters, etc.) ❑Yes 1
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. ❑❑ the {lush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Mona : omments and/orDrawings:
5100

13 Division of Soil and Water. Conservation - Operation Renew [
• ;f 13 Division of Soil and;:Water Conservation -,Compliance Inspection'
,■ DiAsion of Water Quality w Gomphance Inspection ,
s" „ r
.,, .13 Other Agency - Operation Re0ew
Q Routine Q Complaint D Follow-up of DWQ ins ection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
13 Permitted 0 Certified © Conditionally Certified 13 Registered 113 Not Opera hate last Operated:
Farm Name: .. tiveg.... 1.'.1.1 l/v<..... S'4 ....... ............................ County:.....................................................................................
OwnerName: ....... -at i. .............��r��............................................. Phone No:.......................................................................................
Facility Contact: .......... M c . ...........................................Title: 40wvallk ............. Phone No: .....................................
Mailing Address: Ip..�.��......1��i���.....> ?r ....fi.r�... �7' ....F.{. o. i (.4.....0�............ 1036<
,Onsite Representative:....�r+I..VC::...�'................................
Certified Operator:.......&.!�L.................................... Operator Certification Numhcr:....... fr�.,�l .............
Location of Farm: I -
I.atitude �' �° •� Longitude 17CLI • I izz,,4 EZ�r-16�
t ' Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
Feeder to Finish
p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts I
❑ Boars
Design, Current Design Current
Poultry Capacity Po uI tion Cattle , Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ID Non -Dairy
❑ Other
Tatal.Design Capacity �. p
T.Total SSLW
Number,of L''aigoons rgSubsurface Drains Present ❑ Lagoon Area Spray Field Area
r.. Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )kNo
Discharge originated at: [I Lagoon [I Spray Field [I Other
a. If discharge is observed, was the conveyance man-made'? [I Yes [I No
b. If discharge is observed, did it reach Water of the State? (If yes, nolify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does dischargc bypass a lagoon system'? (Il'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
Structtre I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 ?.
Freeboard(inches): ...........z................ ............tq-............................................................................. .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes XNo
❑ Yes KNo
❑ Yes JxNo
❑ Yes XNo
Structure 6
❑ Yes Wo
Continued on back

Facility Number: 1 — Mite of tnspec•tion
I lrf l
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify ❑WQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes )(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ;tNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ANO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes ANo
12. Crop type
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?
El Yes 'XNo
b) Does the Facility need a wettable acre determination'?
❑ Yes XNo
c) This facility is pended for a wettable acre determination?
Cl Yes KNo
15. Does the receiving crop need improvement?
❑ Yes No
16, Is there a lack of adequate waste application equipment?
❑ Yes No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ❑ No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes 9 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes "'No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ❑ No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
24. Does facility require a follow-up visit by same agency?
❑ Yes No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes X—No
I'Vri yiMp ioiis •off . cpencipij Wore )nOfed. iiW.Mg 0!S'vjsjt' -:VOO will -t&Oiye lid fui�tp�r
ctirresi�an�ience. about this visit........ ...................... ....'
Comments (refer,to'gi estio.n`#)ci Explain any YES`answers 'and/or;atiy,recommendatiotris or any other` comments.
:Use drawin ..s of facili to better ex lain situations.' use additional pages as necessary):
I '
g ty z. P (. p g ry
L S 1>0 / M6 A- 6"Z) Jm 8
u)AI 1 A-7- rRf- • Fh-e t i r�
Reviewer/Inspector Name
Reviewer/Inspector Signature: / ,l,rDate:
3/23/99

Faci ity Number: — Date of litspection tr
Odor Issues
26. Does the discharge pipe from the confinetnent building to the storage pond or lagoon fail to discharge at/or below ❑ Yes AN❑
liquid level of lagoon or storage pond with no agitation?
27. Are there any dean animals not disposed of properly within 24 hours? ❑ Yes xNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes.ONo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �`] No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XN❑
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
Additional Comments an nr ra►wings:
X/Q 7-
A-671 *7r7&N
VIA -§Ire' -.
j7. C..n.,��r�. f-GlJg rirAl,eSa Alar-v t1672
Owe&. ;�>Q &,e A�r ,66yG167- ��� . OAle y .
1� ��r WP,-It �1)PP[ 17 &&et6 f-Ld re fkn 6S
A -Al oa&0e- L"de-' /
3123/99

''' -b-#�iyision i and Water Conservation .DIvIsiono Water r Quality_
10 Routine 0 Conmlaint 0 Follow-un of DWO insueTtion 0 Follow-up of DSWC review 0 Other I
Facility Number
13 Registered If Certified 13 Applied for Permit 0Permitted
Farm Nurne . ....... 0/i.qjtj ....... KL vr ...........................
Owner Name:........!(( Vtr.S.1 ....................................................
Date of Inspection
Time of Inspection I T.-§:5-,--j24hr. (hh:mm)
j[3Not O2erationaI_j Date Last Operated: ..........................
..... . County:.... .................................... ................. --.
PhoneNo:... ........................................
Facility Contact: ..... h . ..... kWj.j.< . ................................ Title: ........... 00,'-s . .................................... Phone No.
Mailing Address: ....... MxwakN ...... A 15x- " 1. j ..... V. - 3r
..... J ................................... .... 01"i"tt .................................
Onsite Representative:...... ohvry.. ...... 541k . ....................................................... Integrator:. -...Wu . . ...... . &V, . . ............ ........................
Certified Operatorz ............................... ............ ...... ............................................................. Operator Certification Number;,,,,,,r ...........
Location of Far-m.
r JM'.
r ----- I r.; U% 0 r, Wes -vie
Design z� ::Current`:' Desi Current `�i Current-
urren
CitikitiTo6l 6 fi,- e ava l[tv' t Fx
Swim, avacii wkovulati6n, :Poultry.. D 4 0 6iti C ' C ; PoiDula, lion:
Lagootis 1 Hnlding;Pnnils.j Subsurface Drains Present:] 0 Lagoon Area Spry Field Area Fi!�
No Liquid Waste Management System
is
General
1. Are there any buffers that need maintenancelimprovement? D Yes ISM
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon [I Spray Field [I Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? t,[f yes, notify DWQ)
c, If discharge is observed, what'Is the estimated flo%v in gal/min?
g -
d. Does discharge bypass a lagoon system'? (Il'yes, notify DWQ)
3. Is there evidence of past discharge from any pan of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoonsfholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
0 Yes 51 No
0 Yes V.] No
C1 Yes
P No
4A
❑ Yes
IX No
❑ Yes
04 No
0 Yes 0 No
D Yes F No
El Yes W1 No
El Yes 14 No
Continued opt back

a o6
Facility Number: 3
8. Are there lagoons or storage ponds on site which need to he properly closed? ❑ Yes No
Structures (L.,woons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure C
Identifiat: ........ I......aY4' lA ............ ,...... l.......................................
Freeboard (ft):..........4..................... .............. ..X............. .................
.................. ............................................................................................................
10. Is seepage observed from any of the structure::? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes EK No
12. Do any of the structures need maintenance/improvement? �A Yes ❑ No
ar Any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? Yes ❑ No
Waste, application
14. Is there physical evidence of over application? ❑ Yes JZ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type hen,.U..R......................... 5.0.0... ..�tYittfl.......... -.. ;,,,11........... �rkYl!'►4.................................... .......... ....
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 1,% No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes K,N❑
18.
Does the receiving crop need improvement?
❑ Yes
J&No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
Yes
❑ No
21.
Did Reviewerflnspector fail to discuss review/inspection with on -site representative?
❑ Yes
Pallo
22.
Does record keeping need improvement?
Yes
❑ No
For
or Permitted Facilities On[
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
14 No
2.4.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
D9 Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
®No
0. No:vitilitions•nr deficiencies. were 6o4d_during this'. visit" , :Yo-U.4ill i&ei-ve;na further .'
Oerespbndehce about this:visit.
Lomimprtts (refec.to: uestian.#): Fit latn;ari. iYFS answers and -or any,,recamiitendations;oi :ati '�itfleir;corrithieiata. ,
'
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7/25/97
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Reviewer/Inspector ector Name _;, ;t`=, S 3
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Reviewer/Inspector Signature:— irate: