310480_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

0
• C�Division of Water Resources /
acility Numivision of Soil and Water Conservation v
Other Agency
Type of Visit: Co nce inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: t OQ County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: A T"
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Integrator:
Certification Number: ( 7Z3 7
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cattle
DairyCow
Design
Capacity
Current
Pop.
an to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dp P,oultrF Ca acit Ra .
Lavers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes � o [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
E] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
/ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

,acility Number: - L{ O Date of Inspection: Z f
GVaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-1To ­❑ 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: ( Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 t eat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes M No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
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
�o ❑ 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
90 ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspecti;No
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 install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fact] i Number: jDate of Inspection: L4 7 Ir7
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes 0"Nor❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No [21'lIA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ff No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[;)-f,4o❑ 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
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑'No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
l__I �" ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑Yes
No ❑ NA
❑ NE
Comments'(refer,to question,.#). Ex0lain,6nyYES.4nswers and/or -any additional recommendations or any,other comments:
--j
Use drawings;of facilityJ6Jbetter explain situations (use.additional pages as necessary).
fe-A t' r-\. /C r K 0 ( d-S ( Cp 0 (_11 -, . J__
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
CA
Phone: I (D 7 7 G 73AY
Date:
21412015

ygo
Type of Visit: a Compliance Inspection V Operation Review Q Structure Evaluation iJ 'Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
I YII
Date of Visit: -t t Arrival Time: Z Departure Time: © County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: R- t e—n Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1 7 > y
Certification Number:
Longitude:
Design Current
Design
Current
Design
Current
Swine Capacity Pop.
Wet Poultry
C**opacity
Pop.
@attle Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Dai Heifer
Feeder to Finish 11
Farrow to Wean
Dr, Pvultr,
Design
C•a xcit
Current
P,o P.
D Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
keys
Other
Turkey Poults
Other
Other
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Vo ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑No ❑NA ❑NE
❑ YesK
NA ❑ NE
F,
❑ Yes NA ❑ NE
Page 1 of 3 21412015 Continued

4
Facifl Number: - 9 Date of Inspection: 10 fi
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ea-N—o ❑ 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:_ Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37 3 I
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 q-K`o❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [,YNO ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ 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
0 No
❑ NA
❑ NE
'NNo
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Z(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0--No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
WNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility tail to install and maintain a rain gauge? ❑ Yes 60 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fn No ❑ NA ❑ NE
Page 2 of 3 1 21412015 Continued

Facil!q Number: -14 & Q Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 0 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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes P"No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No
❑ NA
❑ NE
dN o
❑ NA
❑ NE
ECNo
❑ NA
❑ NE
NNo
❑ 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).
C o/ C S („o It -9 �� C
tVec,— 1 5�� ae,4�f'5 J ,� ,��
Reviewer/Inspector Name: U/ A. t- f C, (/o (
Phone: !(Q 77 6 73o y
Reviewer/Inspector Signature: ��-�'�'C ��-"( _ Date:
Page 3 of 3 21412015

PIJ
(Type of Visit: U Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
V I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:I '� J()o 7 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 1 LG'1 L< C ci
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 1 7 Z-3 7
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
Layer Dairy Cow
Design
C*apaclty
Current
Pop:
ri to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
16,00
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D P,oultr. Ca acit P,o
I a ers
DryCow
Non -Dairy
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Other
Other 1
101
Turke s
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[:]NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Qfilo
(DNA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Faeilit Number: Date of Inspection: 7Y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E!rNo ❑ 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 E No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [3'1<l0 ❑ 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 E!fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q 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 [r]`No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [: o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EfrNo ❑ NA [] NE
acres determination?
17. Does the facility lack adequate acreage for land application'? ❑ Yes f No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes El —No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20. Does thefacility 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
E31�o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
d 1
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJ No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Fkility Number: Ds ection:
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 l3`lgo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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
pen -nit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
D No
[DNA
❑ NE
❑ Yes
❑ No
[i]' 1�A
❑ NE
❑ Yes
Dr-N
❑ NA
❑ NE
[] Yes [TNo ❑ NA [] NE
❑ Yes E 110 ❑ NA [] NE
❑ Yes [ No ❑ NA ❑ NE
E] Yes No
❑ Yes [3 No.
❑ Yes L'J o
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Reviewer/Inspector Signature: ��`V (� �"Date: 7Z(ollj—
Page 3 of 3 21412015

Type of Visit: G<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ,�Routinc 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 Arrival Time: Departure Time: County:. Region:
Farm Name: X�_ _,v-? Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 6 &IZ4 kL"Z��w
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Avle!!�
Certification Number:
Certification Number:
Longitude:
Design Current
Design
C*urrent
Design Current
Swine Capacity Pop.
Wet Pouitry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
[)t P,©ult ,
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes )E:rNo ❑ NA ❑ NE
❑ Yes �No
❑ Yes P116
❑NA ❑NE
❑NA ❑NE
❑ Yes Eno ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
�. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes O'No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yeso ❑ 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
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes ,[!I_No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes_,,�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 0No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4!fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes,,,allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes � ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes E] No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes _4�&o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PMo ❑ 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 1�1Qo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes —E7No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of ins ection:
r24. Di.4 the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2-11;b ❑ NA ❑ NE
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:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes M­No ❑ 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,,21'glo ❑ 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)2-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 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ;3No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ED No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes -E!f'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes oNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawint;s,of facility to better explain situations (use additional pates as necessary).
Olklly
7�
l3 /_ G
3 .
/,c7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �47k.A�f
Date: Z Z
2/4/2011

I
Type of Visit -0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance -
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ( O Departure Time: r� County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:'
Certified Operator:
Back-up Operator:
Phone No:
Integrator: lk_zdg
--ea, /E57s-,V
Operator CertiBca io Nu r: 1 72 -5 -7 —
Back-up Certification Number:
Location of Farm: Latitude: [::] e = ' 0 Longitude: ❑ e ❑ ' 0
Design Current
11111 1111 Design Current Design
Current
Swine
Capacity Population
Wet Poultry Capacity Population Cattle C•ap�c`ty
Population
❑ an to Finish
❑
La er
❑ Dairy Cow
❑ an to Feeder
❑ Dairy Calf
-Layer
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
Stocker
El El
❑ Non-ts ers ElBeef Feeder
❑ ❑Beef Brood Cow
Gilts
Boars
❑El❑
Turkeys
Other
❑ Turkey Poults
❑ Other Number of Structures:
❑ Other 77
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
,'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
ONo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P*Ro
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Date of Inspection
Facility Number: - o)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes f a'No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes [ ,No
❑ NA ❑ NE
Struc ure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ;lNo
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ,❑'No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes )2-No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
_E�-No
9. Does any part of the waste management system other than the waste structures require
❑ Yes [�INo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes [�-No
El NA El NE
. maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ;�,No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes j'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ,a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ENo
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
Cl Yes JQNo
❑ NA
❑ NE
Comments (refer to question #): Explain;any YES.answcrs and/or any recommendations nr any ether-icomments�, a a,
.Use drawings of facility t6i better. -explain situations. (uscvaciditxional pages�as necessary)
k
Reviewer/Inspector Name �� � �� - ii � ; Phone: -
G %
.� � $ "Wilt_' �
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

J
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )2No ❑ 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. ❑ WDp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;:jNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑01io
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
j'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ON o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LNo
❑ 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
�Ko
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Je}No
[__1 NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
;],No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O—No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Flo
❑ NA
❑ NE
Additional Comments and/or Drawings:
7/& f, y
le /
/o//
7 llzlld ,
3.6
2, 3
I'd
Page 3 of 3 12128104

I Type of Visit lj�)torn liance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
�i
Reason for Visi Routine O Complaint O Fallow up (! )°Referral O Emergency O Other ❑ Denied Access
Date of Visit: L1.LLLJ" Aral TiFje: ;t7 eparture Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
4
Phone:
Facility Contact: Ti e: Phone No:
Onsite Representative: A�7AIntegrator:
Certified Operator: Operator Cer mcation Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 ' =" Longitude: = ° 0 ' 0
Design Current.
I U Des*gn�urrent
Pommy'
Cattle
L'®resn C►urrenSwine
;Capacity Populaf own
a Wet Capap llaatiop
paeity Population
Wean to Finish
F
La erDai
PO
Cow
Wean to Feeder
Non -La er
❑ Dairy Calf
❑ Feeder to Finish
airyHeifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Stocker
Gilts
❑ N ers
Beef
❑ Beef Feeder
FBoars
Nets
❑Pullets
❑ Beef Brood Cow
El Turkeys
Other
❑ I I I❑OtherI
❑ Turkey Poults
Number of Structures:
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0No
❑ 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
ZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑xo
❑ 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? ❑ YesXo ❑ NA El NE
a. If yes, is waste level into the structural freeboard? ❑ YesNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes [/No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes O"No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes grNo . ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;Z 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 [10 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [7No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) r
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�fo
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
/Pr No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P/No
❑ NA
❑ NE
Comments (refer to. question #): Explain any YES answers'and/or any reeo.minendations or any, other comments
Use drawings; of facility to better explain Wuationsi (use additiotial pages. asp necessary
Reviewer/InspectorName�r'`�`° �''�''�`�kg� '{4{,, Phone:
d_ K 4:i S #i i`
Reviewer/inspector Signature. Date: 2L7
Page 2 of 3 l2/28'/04 ' Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes I ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
P1❑
NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
T No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;3*No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
.KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[,-A"No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PI ;
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
ETNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;�<o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Or
VTql)o d'o
la o4 0q .3
Page 3 of 3 12128104

IType of Visit compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit' outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access I
i
Date of Visit: Arrival Time: ,: Oe� eparture Time: County: h 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 = 1 = Longitude: =° 04
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
Layer
PRI
airy Cow
❑ Wean to Feeder
Non -Layer
❑Dairy Calf
❑ Feeder to Finish
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ La ers
❑Nan -La ers
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Co
Other
❑ Other
❑ Turke s
❑ Turkey I'oults
NO Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 4,XNo
❑ 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 PMo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ;2N
ElNA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes 1 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:' — Date of Inspection
r
Waste Collection & Treatment
4. 'Is storage (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 21
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes o
[Ell Yes No
Structure
El NA El NE
[I NA ❑NE
Structure 6
❑Yesj2'No El NA ❑NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? - ❑ Yes/LI No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes two ❑ NA ❑ NE
maintenance/improvement?
It, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑,1 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PIN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
po
❑ NA
❑ NE
Esi ha, ra a .�yt x 5£ F.t ea Y ��a Jam.- k
C omments (refert to,qu �shoni#) �xpl� } jaTy�Y�ESan�wers�an�d�arl ��y���r�ecommg�n�d�u}tion, s. or any, other eomm�enfs. �� ��� � ;
Use d.r�awings;ofEfacfl�ty�torlietter�expla�n}situatian�{use add�ttonu� pag"es asnec�essary):} �� �� . ,,., . ; � ,a�� e; ;
0Gdrs
ReviewerlInspector Name _ — Phone:
ReviewerlInspector Signature: Date:
Page 2 of 3 c.onrrnuea

Facility Number: �' — Date of Inspection d
G
Reauired•Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q Nb ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
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?
❑ Yes/[SNo
❑ Yes 40
❑ Yes o
❑ Yes //ICJ No
❑ Yes ZfNo
❑ Yes ZO'No
❑ NA ❑ NE
❑NA ❑NE
El NA El NE
❑NA El NE
❑ NA ❑ NE
[I NA [I NE
❑ Yes Pj<o
❑ NA
❑ NE
❑ Yes 2N
❑ NA
❑ NE
❑ Yes ' No
❑ NA
❑ NE
❑ Yes�No
❑ NA
❑ NE
❑ Yes No
NA
❑ NE
❑ Yes o
❑ NA
❑ NE
Additional Comments and/or Drawings:
1
L /0/0?e G
131a r-
12128104

I
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint 0 Follow up O Referral O Emergency 0 Other - ❑ Denied Access
Date of Visit: l evil-, 16 / I Arrival Time: f `7
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Departure Time: County:
Facility Contact: dqTitle:
Onsite Representative:
1w6keze?. L.WZA=-
Certified Operator:
Back-up Operator:
Owner Email -
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: F—] e 0 6 0 g, Longitude: 0 0 ❑ 4 =
di
Design Current" Design Curreut t �y,� �Design .Curret
Swine Wet Pollry
Capacity Population Capacity PopWttors .Cattle Capacity Populaton
`
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La et
❑ Dairy Calf
[aFeeder to Finish1XLj(e)q
Dry ]Poultry,A
Dairy Heifer
❑ Dry Cow
❑ Non-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
-Layers
❑ Pullets
❑Beef Feeder
❑Beef Brood Cowi
❑ Boars
El Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Otherl�
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility NPfflber:3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes []No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes . ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question#}; Explain any YES answers,and/or any:recommendaho.ns or,any other com..ments..
Use drawings of facility to better'explain situations. (use additional pages as necessary)-.
T
Reviewer/Inspector Name _ w I Phone: — �O82
Reviewer/Inspector Signature: Date: 2% D
Page 2 of 3 12128104 Continued

Faeility'Number: 01 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
w /N
d/910 7
12,128104

r ( Q',Drvision of Water Quality
Fhlltty Number 3� 78� 0 Division of Soil and Water Conservation
Other Agency
Type of 1/isit Q'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit JeRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3n/ Arrivalzlel
alTime: �/r�� Departure Time: County: 1v� Region: _ z
Farm Name: _L��thGl�Cil t6/ozy_ �[ti� _._.. . Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Q 410e"'g
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator: `
Operator Certification Number:
Back-up Certification Number:
Latitude: e =' =" Longitude:
::.:Design Current. Design Current; .
Swine ,; :CapacityPopulation Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey POL11tS
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design; Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of. Structures: =I,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes j2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
5o
❑ NA
❑ NE
❑ Yes
.J-Ko
❑ NA
❑ NE
12128104 Continued

Facility Nwpber: 3 Date of Inspection 3 6
R
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes ❑'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [--]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑1No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes El`No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [)-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0-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 [I NA ❑ NE
maintenance or improvement? !i
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [R'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
!!![� No ❑ 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 and/or any recommendations or,any other comments. ,
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name G/�l%` ' Phone: (J- 7 `` .2
Reviewer/Inspector Signature: Date: .3 Lg 1616
Page 2 of 3 12128104 Continued

a;
F-cility Number: Date of Inspection
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,07FIo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 21 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ZNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
ErNA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
;ZNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
2NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P-No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U-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 duality 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
[:jNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
.❑-No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
r_' ido
❑ NA
❑ NE
Additional .Comments and/or Drawings:
4
T
Page 3 of 3 12128104

Type of Visit (>,dompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit p4outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Qw/c, '441
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o❑ i 0td Longitude: ❑ o= 6 0 {Y
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ pry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder '
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
.r,-040
ElNA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — (2 Date of Inspection #ob-
3YPjkte Collection & Treatment
k� 4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes 914o ❑ 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: I�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes _2NO ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0-No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 21*No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E2 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 ❑ 10 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q-NO ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J:;-No [INA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) A'6 '
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
2No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ErNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
eNo
❑ NA
❑ NE
T:�lr' t s � " '� aGCL S
I-e G G rct 5 J V a �- a-
i ►-��o Ci G� ®r t
Reviewer/Inspector Name.Phone: �lG c3L �c3Lii�/
Reviewer/Inspector Signature: Date:
12/28/ 4 Continued

Facility Number: 3 — Date of Inspection
Aeguiired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes []-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .R'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Lallo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
,211NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
8'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
E"NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
.8 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ej 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
..0'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
2No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
12 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
• r es-t� J Comf a r s2 Z e SC, v
Plk7le_ cc,7- 1 r�
araK l /Dr'a " Z
so l r �� G� ���w elAotpv
12128104

Time:
,J21Fermitted Mertified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName: .a� YI !3/....f1.�%Z+YL �I.. Q m....................................... County: V �_..................................................
OwnerName : ................................................... ........................................................................ Phone No:
MailingAddress: ..................... ........................................ . . .................... ........ .............. ...... ..................................................................................... ..........................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
OnsiteRepresentative: L7414 y ................................................... Integrator:. A.,.r'�ld)....................................................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 0' 44 Longitude • ' «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Z['�o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/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 ;2�90
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 90
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )ZrNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:............j ................... ............................... .............................................................................................................................................
91
Fre;cboard (inches): -1
12112103 Continued

Facility Number j — 0 Date of Inspection f p
5 i Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑yeso
seepage, etc.)
PK
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes L�.No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ;2 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ;31f4o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes PKo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 1?<0
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 2'l10
❑ Excessive Ponding ❑ PAN ❑ Hydraulic` Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ��r�iv�lir.�Gt l q / `5 �OYiY�I'�Pa
13. Do the receiving crops differ with those designated in the Certified Animal Waste
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?
Plan (CAWMP)? ❑ Yes J2rNo
❑ Yes ZNo
❑ Yes ,erVo
❑ Yes EfNo
❑ Yes ,0790
16. Is there a lack of adequate waste application equipment? ❑ Yes P-No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ANo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ."No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 2NO
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 'PXo
Air Quality representative immediately.
77-
❑ Field
❑ Final Notes
e2116 60 a a�'l4 ovyr
" /�d' f//-o& CCt' �C�n ez/
1 aQYI z
vc< /X
Reviewer/inspector Name
Reviewer/Inspector Signature:
Date:
PU
■ aiuiuo t,unginuea

Facility Number: —YjV Date of Inspection
Required
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ❑ No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑ Yes o
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ��o
❑ 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 ET No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes 0-90
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes E:rNo
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes R No
28.
Does facility require a follow-up visit by same agency?
❑ Yes ;ffNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes AONo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes ;3'lqo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall []Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
' ! 4i
atttonar o►nmentsandlorDrawtngs �� i,�,. ; �, , .�;�
�._. uw...
�- /1/�w -0 G w �s �zU cJl�h
hrJ nCe7 .beer �'�C i'�� cl/
gr
1211210.3

Facility Number
[late of Visit: Time:
/
Not O erational 0 Below Threshold
UPermitted Wertified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: T� o ts,�, !r✓l,.i __ _ _ County: AV),1
Owner Name: An Z Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: 47i d a ✓
Certified Operator:
Location of Farm:
Phone. No:
Integrator: _� �.�
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0' 0" Longitude 0 6 CC
Swine
Design
Ca aci
Current Design Current Design Current _
P.o ulation P,oultr Ca aci Po ulation Cattle Ga aci P,o ulatian
❑ La er ❑ Dairy
❑Nan -La er ❑ Non -Dal
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean'
❑ Farrow to Feeder
r„
❑ Other
Total Design Capacity
Total SSLW
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons F-2— ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Salld Traps 0 ❑ No Liquid Waste Mana ement S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection _& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): Dili 74
05103101
❑ Yes ERN o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes RNo
❑ Yes RNo
Structure 6
Continued
%x

Facility Number: 3 — 44,p
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes M No
❑ Yes [Z No
❑ Yes ® No
❑ Yes 0 No
❑ Yes ®.No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes EffNo
11. Is there evidence of over application? ❑ Excessive Ponding ElPAN ElHydraulic Overload ❑ Yes 0 No
�i Z)
12. Crop type �Z �iA 4//
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes JZ[No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes IZLNo
b) Does the facility need a wettable acre determination? ❑ Yes RNo
c) This facility is pended for a wettable acre determination? ❑ Yes M-No
15. Does the receiving crop need improvement? ❑ Yes bNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
P9 No
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
NNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
�INo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
MNo
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
MNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
BNo
23.
Did ReviewerlInspector fail to discuss review/inspection with on -site representative?
❑ Yes
�No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ONO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
CdNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer tb .question #) .Uplalniany YES answers and/or any recommenclattons or any tither'comments: R.
,, w
,� y
Use drawmgstofdfacllitytoobetterexplaln situations. (use additional pages as necessary). ,, ❑ Field Copy ❑Final Notes l
� r� i. . � ., .x.. '.F
✓ �r Q �C 6I W �i� dot �' S.t f`v�7� �1 ✓ (,vE"� f�dt 4h ����
ReviewerlInspector Name : ;/
!
Reviewer/inspector Signature: Date:
05103101 Continued

Facility Number: 3 -� Date of Inspection 13 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 10 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 NLNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes OkNo
roads, building structure, andlor public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes Zko
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 $;rNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes C No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes f;VNo
5100

`Division of Water Quality
k Division of Soil and Water Conservation' `
} i Q .ptli& Agency:, k
f Type of Visit 'Compliance Inspection O Operation Review O Lagoon Evaluation f
Reason for Visit eRoutine Q Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 3/ Q Date of visit: �1 Ti ne: ® Printed on: 7/21/2000
Q Not Operational Q Below Threshold
,C"ermitted 0 Certified j3 Conditionally Certified ❑ Registered Date Last Operated or rAbove Threshold: .........................
Farm Name: .................... �..I�r1 hv�l.... .F�`. .r"� County:.c�..i1.{..!.`..........................................................
Owner Name:
.''`..7................................................................................ Phone No........................................................................................
FacilityContact: .................................. .............................................ritle:................................................................ Phone No:...................................................
MailingAddress:..........................................................................................................................................................................................................
Onsite Representative:...... ��'.v-1q j......�jtl h! .. ... Integrator:.. ✓'r..... ........................
................................... �..
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location 'of Farm:
© Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 66 Longitude • d it
gn Current
Canacity Pootilation
an to Feeder
der to Finishrow
E
to Wean
row to Feeder
Farrow to Finish
El Gilts
Boars
Design Current Design CiEr e>ot
Poultry Capacity Population Cattle Capacity..:,Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design, CAPAcity
T61W.SSLW `
# ataber,of Lagoons 2_ ❑ Subsurface Drains Present 110 Lap -non Ares 10 Spray Field Area
Holding Ponds / Solidir'aps: ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ,2fNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) Cl Yes 9 No
c. If discharge is observed, what is the estimated flow in gal/inin'? yl /q
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ON
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZVNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes '12'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...............I.............................2...............................................................................................................................................................
Freeboard (inches):
5100 Continued on back
Q

Facility Number: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes �'�io
seepage, etc.}
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes P<o
(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 fijrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 13 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes �No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload
❑ Yes [VNo
12. Crop type _32_ + vfi(e, Prk.9 j u rP 1 S5 v— 2 r. V! G r 4 ,l n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes,ZNo
14, a) Does the facility lack adequate acreage for land application?
❑ Yes Z&o
b) Does the facility need a wettable acre determination?
❑ Yes X",o
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�eNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes )ZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? ///
(ie/ WUP, checklists, design, maps, etc.) ❑ YesNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑'l�o
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 13_�o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 0
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative' ❑ Yes /'01No
24. Does facility require a follow-up visit by same agency? ❑ Yes/f!fNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes_IZ('No
yiQlatFigrjs:or ilofcjencies re p0te�1 d>�rring this:vjisit� Yo>�t �vil� ree�iveo i'u>�•t#��r:
correspondence: ab66f this :visit:
•,. rt,
Comments (refer to question #}c Explain any YES answers and/or any recommendations or any other comments , t rJ i r
r
Use drawjngs of facility to better explain situations. (use additional jlages
Fr�gA,
OX— �� rzC0r ,511 Grp we(� ke��. fie. -move Srvtct� qr'��r► - " F ,IA. .
y J
Name Reviewer/Inspector
p 1�] D hC''w41�
�1
Reviewer/Inspector Signature: Date: 41 Iglol S/�

Facility Number: Hate of Inspection L-f�--�-1=- }Tinted on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 01yes ❑ 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 '11?�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes J�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 E:(No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 1(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional: Comments an or ra ngs:
5100

t�?r�- � ti `r „� -: L xi {F I'-. I I i bl� hi ,, �r -.: 4i 4r�, _,.� t ! . h�l p •t .ti ,ttl .v i � azi' .i,J�W ,� '^✓ f
s _.r.► 11 � �r h
i Q,Divrsion of Soil and Water COnserVat,On ' 54f e}
�k x i a 3 i.
f do {i..�'f� �, l,�r -� pis. a s O,OtheC'AgeI1Cy, r t. s �s } t r rrc �}F -'r ki i�y'6s .a
k
m �' �."' .,:�.� tii :�. s. �i fir. ... .... ,. .,r i-.T�� N "`�i,.r �... .�:. .� u'vf__�"� �f_, c..._. RY?'. -.. ,r r4.: r , .. _ _. ... .. . _ .. .,:
of Visit ® Compliance inspection Q Operation Review Q Lagoon Evaluation
IReason for Visit m Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number [)ate of `Visit: j Z 7�t't9 Time: Z 4 Printed on: 7/21/2000
Not Operational 0 Below Threshold
® Permitted ® Certified [3 Conditionally Certified © Registered . Date Last Operated or Above Threshold: .........................
Farm Name: ............ .�iy...FA.g..r`.'.t............ ...... County:...........�Pe!-.1.!4.......................................
Owner Name AND EN — y Phone No l ra — .Z '�
FacilityContact: ...............................................................................Fitle:................................................................ Phone No:...................................................
Mailing Address: 1462 5,l¢ND...K� D��.t`z ...1 4�..... .P/N/�...�iLG,c.....N.C.....a 7.y.......................... ..........................
OnsiteRepresentative: lU �C NEIntegrator: UQP .y..••••••..Afiyc e4�1
fR.............................................`................................... ,, I............N.......!...�.........................
Certified Operator :..........
% N y..... (.•t..�rNNQ, t�.................................. Operator Certification Numhcr:......1 . 7...........
�a 3
Location of Farm .
B�C,�— �P- ,Q�NA9 /�t�NNED l &q
U2rrt of e?N West- 5t a of- SR 173Z N-PP"X O, flctile arf-k 0 ,1�33
Swine [3Poultry ❑ Cattle ❑ Horse Latitude E3_40' 0° ®+° longitude I 7T • 4 7 < Z Q L{
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
10 Layer
❑ Dairy
Feeder to Finish
116 p
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
10 Other
❑ Farrow to Finish
Total Design Capacity
a y� 4l
❑ Gilts
LEE
Total SSLW
(�
❑ Boars
Number of Lagoons Subsurface Drains Present 110 Laron Area IM Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Im acLS
1. Is any discharge observed from any part of the operation? ❑ Yes Wo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If•discharge is observed, Nvas the conveyance man-made'? ❑ Yes ❑ No
h. if discharge is observed, did it reach Water of the State'' (If yes, notify DWQ) ❑yes ❑ No
c. If dischanx is observed. what is the CS61TIMCCI flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes �rVo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes r
0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes KNo
Structure i SuRucturc 2 Structure ; Structure 4 Structure S Structure 6
Ideati l'i er: ............. .... ............................... ............... I ......
....... ............. .......................... .... ............................ .... ................. .... ......
.........
Freeboard (inches):
5100 Continued on back

Facility Number: 31 — 480 Date of 111spectiotl Printed on: 7121/2000
5. Are "here any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion, [I Yes 5�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 00
(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 O No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Ij No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [No
12. Crop type F3cr'r>4_kdu 4 5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Ilo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes '�(No
b) Does the facility need a wettable acre determination? ❑ Yes $&o
c) This facility is pended for a wettable acre determination'? ❑ Yes No
15. Does the receiving crop need improvement? ElYes No,
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
K 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
U�Vo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�(No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J�No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
Cl Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�] No
,
K4j •vigla(i6ris;or doPciendieg *� re note#. during this;visit: - Yott Will •receive lid further • ; ;
icories &idence: about: this visit
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
fL-A9_oA LAFKOD C%0Vr> A-- 6WJ>
A�
w
Reviewer/Inspector Name PSI G . p�E7T`
Reviewer/InspectorSignature: Date: !I%Z/ao 5100

Facility Number: Date of Inspection 1 Z Da 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 Utor helow 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 t�(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes (7rNo
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 2�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 ANo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a peimanent/temporary cover? ❑ Yes 6640
Additional! • omments and/orDrawings:
ya
.1MAL
5� I'133
5
ul I,fto
R►4t L 11a
h tip°
3�ul4�rl�e,
�GjtfANSV i-C
5100

0
:r ;.
t [j'Division of Soil and Water'Consei-vation Operation Review' ''
11,
s , , 13.Div sion of Soil and Water Conservgtion,' ,Compl>Eance Inspection,{ €,�r'4
Division of Water Quality d €Compllance Inspection 3', i 7: € E r ', arf m
�l
OtheYI t 3�` i s t °n,� -71 ° '
i Agency - Oper>itaexi Review .. , '
a.
Routine O Complaint 0 Follo!�'-up of DWQ inspection Q Follow-up of DSWC review Q Other �
Facility Number Q Date of Inspection )
'11me of Inspection F 9; D 5124 hr. (hh:mm}
Permitted j] Certified ❑ Conditionally Certified 0 Registered Not Operational I Date Last Operated:
Farm Name: .............�.C�. k. ..........I�Lnrijy.. rly.41P.11.rl..................................................
........
Owner Name: R&n.1 .........nn aL..................................... Phone No:.......L.. ..'.. ..1..�..r.... ........
...............
Facility Contact:Title:f.................................
............................................................................. ........du ?.'at-Y.................. No
,,JJ CC __ 44 Q ' f
Mailing Address- ..1 1Q........-..?.ajih .....R t.......:!�ad ........pa.►'��.....l....1.�.1.�.....J.c...................ZY-r�. J_z...........
OnsiteRepresentative: ...............I.................................................. ... Integrator:.... 11.u/..� l.......................................................
Certified Operator: .........Rk IOC ........................K411f.l ............ Operator Certification Number: ......... �. ... 3 �.........
Location of Farm:
.............................................................................. ..................... ................... r�
Latitude ' 6 " Longitude 0 ° is
Design Current' .. "Design Current "' Design Current
�Svvine' " Capacity Population I'oult�ry. r ,,,Ca�ae it : Po "elation , ,Cattle; Ca acity Population
❑ Wean to Feeder ❑ Layer " �] DairyJX
pi
Feeder to Finish ,Z 1E] Non -Layer JE1 Non -Dairy'
❑ Farrow to Wean
[] Farrow to Feeder ;r ❑Other
❑ Farrow to Finish
, �''' `' �''' _ Total'Designt Capacity
❑Gilts) :'I: 11+I iO4E1..-"i}; I It <<
[IBoars 1, Total 55LW
i; W
Number of .Lagoons. ❑ Subsurface Drains Present ❑ Lagoon Area JEI Spray Field Area
Holding'Ponds / Solid 'Traps ' ❑ No Liduid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes j)No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes �/No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ] No
c. If discharge is observed; what is the estimated flow in gallrnin'? u
d. Discs discharge bypass a lagoon system? (Il'yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes 0No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes I�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 14 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............3 .�o.........I.. .....................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on b ek
I

A
T
Facility Number: — fa I)atr of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an ,
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require niaintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ikpPlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of overplicgtion? ❑ Excessive Ponding ❑ PAN
12. Crop type
V
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, Freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�io�yiolaficjris or d$Cc�encies •were �notea•tlikrtitg •thjs;visit: ;Y:ou�r wiil•rec�ipe �o; fp>�-t�gr � �:
....
orres�oricienceabvut� this visit.
Gomnients (refer.!tolquesfjon #) Explain any YES jan.,
Use drawings of facility to better explain:situations {u
j R . � uA o� 56►1 o-A01s i s11 done,
a4c( Of Ply 1i✓vtL. as %lee-ded- ,
Cl Yes �_&o
❑ Yes N�No
❑ Yes dNo
❑ Yes �I(No
❑ Yes t&
❑ Yes ❑ No
❑ Yes ` Vo
❑ Yes �fo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 6�No
❑ Yes [!No
❑ Yes �No
❑ Yes �KNo
VYes ❑ No
❑ Yes V No
❑Yes �No
❑ Yes WNo
❑ Yes % No
❑ Yes 19 No
❑ Yes *No
additional pages as necessary)_€ t, ' 1 '
.near .at, t, SCrl ,i e,.ii. oL �
�or 1999. have_ ore-. dd re_ orlC—to-
Kf. C+,wJV VIAS ofJ Oe.w (6a-fC poL-�S tir1 -(-(dot O�(�t-i JJS/!145� 11'LSGadact
OrI L ,SeC.4-I O ✓1 OA & W i i 1 t'{� �0.d� L au'1 T�.SG e`� O T t�V d.) k' t t CN 1'G S UP -
A-(3Vt rd.J 1 -QL_(reV I'S in acfjltA+ C04_1461✓7 aria Mr. 64t, y t`s s�Qc�tvl� arJ —
a O^ 12 63-bkrr7 s .
Reviewer[InS ctor Name ri"( � " P-_�Q ti
_�_ - ��� �%l�.�„� € _ .. � _ Ir r..� t�� .tf� II:`=�7i•�I I .,#sl�,��;a it i r:lsr,e�., .. e_E :If„ : :r3&,,..,,
Reviewer/Inspector Signature:
Date: /Z — J?
3/23/99

Facility Number: 31 - G Date of luspection
Odor Issues
-"Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes `i'' "'o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ElYes VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
-1 r o the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional Comments an or D rawinps p g3 q
3/23/99

„� Division of Soil and Water Conservation [3 Other Agency
k
'E Division of Water Quality 't , 1. _”. RJR
Routine' 0 Cam laint 0 Fallow-u ' of 1)W ins ection 0 Follow-u of DSWC review 0 Other
Date of Inspection
Facility Number 31
Time of Inspection 24 hr. (hh:mm)
Registered M Certified Cj Applied for Permit 0 Permitted 113.Not O eratinnal Date Last Operated:
Farm Name: ...............! .M. ."" :'Wi., �f:w.. ...County:..,...N1V1;e............. ...........
Owner Name: +��^V 14- 1r c1 Phone No:....i�.1.14,. .". � ....... �{................. .. 1{....................................
FacilityContact: ............................................................ I ....... ,........+. Title:............................,................................... Phone No:...................................................
Mailing Address:....... JAI ....p.. .!n�...ly1.r............ .. �ih�C ..!�i.i.�..r ...1�G............. �Sl�........
Onsite Representative: .........C.: 1........................................................... Integrator:....... ..............
Certified Operator*.............................................................................:.I.................... .. Operator Certification Number;................. ........
Location of Farm:
..............n.....ie i£T........ .k....ti'.........S.R�...17 ...t...C1:.l...aon �.f�S... A:t . ...... !.-.....' 1;......3.3..T.................................................................................
.... ... .....
Latitude Longitude �• C�' '
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
2.
Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
1
1
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what'is the estimated flow in gal/min?
(J
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3.
Is there evidence of past discharge from any part of the operation?
❑Yes
ID No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5.
Does any part of the waste management system (other than lagoons/holding ponds)'require
❑ Yes
( No
maintenance/improvement?
C.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97
Continued
on back

Facility Number: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed? Cl Yes No
Structures (Lagoons.Ilolding Ponds,.Fluslt Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier ...... .. I.... Z
..... I............................................................................................................... ................................... ..........
Freeboard(ft): .................................... ................ .............................................................................................................................. ........... ,......,............
10. Is seepage observed from any of the structures? ❑ Yes t� No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes (RINo
Waste_ Application
14. Is there physical evidence of over application'? ❑ Yes N No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type r(?!.11d1? ......................' 1'1R l........ . ................ .......I1 .......QKlt;+ltr.Ee� osct �q............
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes .12 No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19, Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certilied or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.vialations or deftciencie's;were,noted during this:visit. You.W'ill receive no further
correspondence alioitt this..visit.-
❑ Yes P No
❑ Yes U No
rot❑ Yes Lp No
❑ Yes 0§No
❑ Yes �&No
Yes ❑ No
Jin
❑ Yes FZNo
❑ Yes No
❑ Yes f� No
Comments (tefer"to question #} :.Explain any`YES answers and/or any recommendations or any other cotnments
Use;drawings of facihty to : etter.explam situations (us. additional pages as necessary}, k
d..... ,
�410,t�
7-�, "+e a"S s tr� 'fie.. 'ja%eu 0, r IRIZ- I
` r. 'c `` S�•ou�d I� e� +~eva*W ..� kjup .
Vrr- • 6M ill Ina) ; t t1 t{
7/25/97
Reviewer/Inspector Name
Reviewer/inspector Signature: ;j ., / l L Date:

101 Routine 0 Com taint 0 Follow-up of DWQ inspection 0 Follow-uR of DSWC review 0 Other
Date of Inspection -1 1 1 R
Facility Number Time of Inspection 1 Z : 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status- ❑ Registered ❑ Applied for Permit (ex:.1.25 for I hr .15 min)) Spent on Review
JqCertitied ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated : ................................... ................ .......................................... ................................... ...................
FarmName: ..... P' .................................. County:.j>"+.f..J..t.yra........ .................. ....
Land Owner Name:... Qt .........15t aa..h.. Phone No:....�..�..�.�..,.`�..'...�.g�.l.................
FacilityConctact:.................................................................................. Title:................................................ Phone No:..........................................................
Mailing Address: ......I.A.1........ . ..a..rn.c�..... +. .q........c.............................P!..'k.. .. ?.�..E f....�...C.,-......._...............,
OnsiteRepresentaHve:....R..Ct x.rya.......K................................. Integrator: .....�1.d..�z.x.PJ...............................................
Certified Operator: .... Kfi M.4....... k:!j ............ .6.aalf!..................................... Operator Certification Num/ber:..17z ......................
Location of Farm:
p�,ea.....va a 5...... s,.i d �.......k.....5...�... }...... a..�.ana..�.,rv^ r, . f�.a.......... ►, t...I.4.�.i...... o .x..0 L ...... ...... ..........
4
3X.�.fx� � ... t..�.�.��....1.�.3 �.......................................................................................................................................................... �
t
Latitude ©' 6 L{ Longitude • <14
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes 0 No
❑ Yes [9 No
❑ Yes 15 No
❑ Yes ® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
No
® Yes
❑ No
Continued on back

Facility Number: ,1\....... ■—.y �.�..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes E[No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures Lagoons and/or Holding Pongil
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
...+........... .............. ............................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes & No
❑ Yes E9 No
❑ Yes KNo
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crap type v..........5! v`�h.4. 7in
............................................................................................
16. Do the receiving crops differ with those designathe Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?.
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes 81 No
[I Yes R No
9 Yes ❑ No
❑ Yes ® No
❑ Yes JR] No
❑ Yes E9 No
❑ Yes gj No
KYes ❑ No
❑ Yes ONO
❑ Yes ® No
❑ Yes 0 No
❑ Yes 91 No
[:]Yes ® No
10 Yes ❑ No
Cbiriments` refer to ` uestioii # Ex laiiu an Y1rS answers and/or an recommendations dr an other comments
Usedrawings,of faclity to better explain situations ! (use addrttonal pages as necessary) y
r ♦
wo I ers ,,, S p t eJ�d .s cue,,, d e _d `J C teLe4
IZ• R w �'°� e t a �-e o'�`�j o *'N w a l 1 S• a k e S v +` (-o
cam, tf o -, �..e—•r v o �.,V -
►$ F� r_ S c-d fi+Le . A is a,
b
1
�., w. �1�✓z 0 +n S P/- rs1-3 C3-tP e}vi . wv wr l�pv3
�: � �: :° tea• ^.:
Reviewer/Inspector Name
Reviewer/Inspector Signature: 9"_ _ O jA r y, Date: •-T t 7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

'
Site Requires immediate Attention:
Facility No. Q
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: t
Farm Name/Owner:
J y
Mailing Address:
County:
Integrator: aig4Y V
Phone: 0 8- S-.2 11
On Site Representative: E;& cx
Phone:
Physical Address/Location: Ne s R
0 3 a 4-r_"5f
c. VCR �i'a%r4t r w C 12
c `7 33 A1 e f-2 /3 kc r lLe.
Type of Operation: Swine ✓
Poultry Cattle
a t.b" «
Design Capacity: f 3 0 _M1._
Number of Animals on Site:
DEM Certification Number: ACE
JJ DEM Certification Number: ACNEW
Latitude: -5q _° S i _"
Longitude: 147 ' 21 ElevationFeet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
.7
(approximately ,1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or 63 Was any erosion observed? Yes or
Is adequate land available for spray? �r No Is the cover crop adequate? C�"'r No
Crop(s) being utilized: Gaqvl?�tr /Syr'rwt.J / rvnarI _ &1 _A_0�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? 60 or No.
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? 6or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or I I If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or T�o
Additional Comments:
Inspector. Name . Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
' Facility No. 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: -T
Farm Name/Owner: R rt,4,_ EA,e.. 2a
Mailing Address:
County:
Integrator: M 4PQjqG.v - Phone: i�Jr�a1 Fr I r r a
On Site Representative: Ncrr,':-fi _-__ Phone:
Physical Address/Location: nye,S �-._ t? 3 -)- t�ll rra `Y A- F00 �Uvv,
i[An�S� � cE• v.rak.r • ` u t `7 3 � /`^�°ry�' � � cL_.1 �4 _
Type of Operation: Swine. Poultry Cattle
s
Design Capacity: _ r a- Z) `i °"'e '` Number of Animals on Site: — 1 D.� � {
DEM Certification Number:, ACE DEM Certification Number: ACNEW
Latitude: 3 y f 9 ' S3 " Longitude: 2-7 -7 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) �e�r No Actual Freeboard: 5—Ft. O Inches
Was any seepage observed from the lagoon(s)? Yes or &ivas any erosion observed? Yes or No
Is adequate land available for spray? Ye r No Is the cover crop adequate? L >r No
p(s) being utilized: CP�r1-*i 1 6e,6r 4� c, -
Cro � _ �-m9lt
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings or No
100 Feet from Wells? ear No
Is the -animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or i� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes'o6)
Additional Comments:
iL v ( /
Inspector Name
Signature
, cc: Facility Assessment Unit
Use Attachments if Needed.