310528_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: 0Com nee Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
� I IIII III. IIII�.
Date of Visit: 7 7 Arrival Time: O Departure Time: 3 County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: A Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
sign Current
Design
Current
Design
Currenacity
Pop.
W
Wet Poultry Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
n to Feeder
-Layer
Daia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D Pon . Ca accit
Po .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10thnr
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Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q-Nv--Q'NA ❑ NE
Discharge originated at: [:1 Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [] Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes [—]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes e V"
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes LsAo
l❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Z Date of inspection: AW17 7
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ro[:] 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): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No D 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 �Noo 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 environmenta reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0<0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ 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 �N
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA NE
Required Records & Documents
19. Did the facility fait to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ 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 Surve
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ No ❑ NA
r
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA rNE
Page 2 of 3 21412015 Continued

Facility Number: 3 f - Date of Inspection:
24.. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA � "E
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
❑ No
❑ NA El<
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 DINE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
44� <)^. �� I
/'U J_ " 4- ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ❑ No ❑ NA E
❑ Yes No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA 2<E
❑ Yes No ❑ NA [] NE
❑ Yes
❑ Yes
❑ Yes
r❑NA ❑NE
:NNA ❑ NE
NA 0 NE
R G` ,4 5 r` e v! i• c--e- C A /—
Phone: 1 (0 0 6 _7 Y
Date: f 2"' 2 L� Or
21412015

Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Beason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (I-//7r/ {,SI Arrival Time: bill? Departure Time: County: t Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator: k" po
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop,
Cattle
DairyCow
Design Current
Capacity Pop.
Feeder
Non -La er
DairyCalf
o Finish
o Wean
o Feeder
o Finish
F
D , P.oultr,
La ers
Design
Ca aci
Current
$o
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
01
Pullets
Beef BroodCow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑-�io ❑ NA ❑ NE
r �
❑ Yese,[D-No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes 'IDNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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?
Page I of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes,,jD-No ❑ NA ❑ NE
❑ Yes ,❑.fig ❑ NA ❑ NE
21412015 Continued

Facili Number: - Date of inspection:
Waste Collegtion & Treatment
4. Is 4orage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �ErNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes 0No
❑ 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?
❑ Yese No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes E:r'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes J2-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.,Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E5-No
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ED'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes eEn'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes -ED-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes .e No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes—e No
❑ NA
❑ NE
Required Records_ &_Docume_nts
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 4allo
D. NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes -E5-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 Q-No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ff-No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E3-No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

t
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes .❑ No ❑ NA ❑ NE
25. ls'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:
25. 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ,;37No ❑ NA ❑ NE
❑ Yes 13 No ❑ NA ❑ NE
❑ Yes J:�IN ❑ NA ❑ NE
❑ Yes EE-No ❑ NA [] NE
❑ Yes ;2-No ❑ NA ❑ NE
❑ Yes PkNo ❑ NA ❑ NE
❑ Yes 0❑i'No
❑ Yes '1Qo
❑ Yes ❑'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: / L _ Date: Z
Page 3 of 3 21412015

Type of Visit: 10zompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Iteason for Visit: fMoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 12= V Arrival Time: Departure Time: County:UjdGki Region: 4—
Farm Name: qn h42C_%A Ale —� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: _
Certified Operator:
Title:
Phone:
Phone:
Integrator: is
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
Dt. P,vultr, Ca aci P.o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
I 113eef Stocker
Gilts
Non -Layers
I 113eef Feeder
Boars
Pullets
NJ
jBeef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation? ❑ Yes E2No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ETNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes rl No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes_.[3-No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes E3'1To
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes 12-1'To'
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: 2- Date of Ins ectiorr
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Fe to ❑ NA ❑ NE
i
a. If yes, is waste level into the structural freeboard? ❑ Yes 2 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 �fo ❑ 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 2-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 J'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes jEr90
❑ 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 J2-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
,,[2-No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, 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 JE No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes ID"F4o
❑ NA
[] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes EerNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes J2�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes JC�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes )23rr'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ;D.No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 155- Date of Inspection:
24. Did the -facility fail to calibrate waste application equipment as required by the permit. ❑ Yes �No
..,
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Z No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ZNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ZNo ❑ 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).
w - _3e See r(L -� �mp� bi cI
�l�Lr F, suf� 44,L5 yexr
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑ NE
❑ NA ❑ NE
Reviewer/inspector Name:
❑ Yes J214o ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
t ok- 0(3(zyc_�
Phone:rja �2
Date:
21412014

t ype o1 v 151t: _�o a:,vmpuance iuspecuon v vperauon tceview V structure r vawation LJ iecnmcat Assistance
Reason for Visit: QlZoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: Departure Time: County7�� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1a1yyYL�., �j t� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
La er Dai Cow
Design Current
Capacity Pop.
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current DEX Cow
Farrow to Feeder
Dr, P,oultr. Ca taciNon-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turkey Poults
Other
Other
Dischar es and Stream Im acts
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)z No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection: t1j
Cato
Waste Oullection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ,,E No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes P]�No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?;
Designed Freeboard (in);
Observed Freeboard (in): T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes ;2rNo
[DNA
❑ 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 J2 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 P 'No
❑ NA
❑ NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ;�r_No
❑ NA
[] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes JZrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes VfNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 6 No
❑ 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.
T
❑WUP El Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application Weekly Freeboard Waste Analysis Soil Analysis [] Waste ransfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes En No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑�No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection: 11124443
24. IZid 4he facility fail to calibrate waste application equipment as required by the permi . ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ['No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes PNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P
No ❑ NA ❑ NE
OtherIssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [2 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
EI 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
�Vo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
TT
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
PNo
❑ 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
No
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
[]Ao
❑ 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). .
Y12113 /At9 OC3 df
((I liewl
CcyL fra l �I'o'6 �-,
Reviewer/Inspector Name:
Reviewer/Inspector Signature: ` V
Page 3 of 3
O uel'a11 lecord5 �
�� �aQ'/
Phone: A79
Date: 41 z1
2144dOII

Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I ar —0d,4lpeparture Time: County: Region: 1%
Farm Name: �� C� h 10 11. rn 7-t %►'� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Pd
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 = Longitude: = ° = 6
Design Current Uesign
Current Design Current
Swine Capacity PopulationwwcPoultry 1 it
:yj
Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer I
❑ Dairy Cow
❑ Wean to Feeder 10 Nan -La er I
I ❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Ury Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Caw
❑ Turkeys
Other ❑ Turkey Poults
❑ ❑ Other
Number of Structures:
Other
Discharges & Stream Impacts
1, is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[I Yes
❑No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes J2%
Ej 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 J2 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 .0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes n No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
jam'
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 allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 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-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
P No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design []Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes k] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA [3 NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: L Zo
24. Did the facility fail to calibrate waste application equipment as required by the permit? s ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes Z No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Z No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes M No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 'Ef No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES. answers and/or,any additional recommendations or any, other comments.
Use drawings of facility to better ex lain situations (use additional pages as necessary)' ° r
l s/r z l (G
a,s lvn s /rI /`� Cv�-�S e?/G i-dU �. ,i/z'ez-Ye,
Send
l"e rrPrA/s ,6y �J— /j3
/ C/ytal/%
/i't�I% r �U/vr ��✓�Q � d
Ncv�lv,� f
L�1i/•��r� n NG a,!,,koS'
Reviewer/Inspector Name:
Reviewer/Inspector Signature: zz_—
Page 3 of 3
Phone: ��/-7
Date: 12 z o L
/4/2011

_ - laivi"sion of Water Quality
Fac}4ity Number - '� Division 0 ' Soil and Water Conservation
Other Agency
type of Visit: 91117ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Ezeason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: . 75. V eparture Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region: ` g&
Design Current Design C►urrcnt
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,oult.9pacity, P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
__LTurkey
I
Turkeys
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [ J�No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
[—]Yes &No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ONE
❑ NA FINE
Page I of 3 21412011 Continued

Flicili Number: Date of Inspection: �—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
7:L
Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ No ❑ NA ❑ NE
❑No DNA ONE
Structure 6
❑ Yes ;'No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ONo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes O'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes O-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 J"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C:�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 �Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes PrVo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ZNo
❑ NA
❑ NE
acres determination?
17. Does the facilitylack adequate acreage for land application?
❑ Yes ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes oNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ;'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes P No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ;:34aste Analysis ❑ oil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections onthly and 1" Rainfall Inspections E21SIudge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'FeTNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fheility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . Yes [:]No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes [:]No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes .0 No ❑ NA ❑ NE
❑ Yes '"No ❑ NA ❑ NE
[:]Yes 2-No ❑ NA ❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
[3 Yes
611 �
❑NA
❑NE
❑ Yes Mmoo ❑ NA ❑ NE
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
�' o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E20<o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, comments ,;-fr,, I'
Use drawings of facility to better explain situations (use additional
lditional ages as necessary)..
l�fr! i1yOw� Gii?a�y d�,5 Cal ev
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fe,co-d s . ra*- rv\c /t�.r IeO6 taleare G-e swe
y66 r PeW e0- sot I /Z7 416 re 7r/ (�J�J C�"/ .s�.S
d eb�r� f�� •3�i"a�?°d`I• �yj f 5jed Cajjj (a�tQy,.s rr 5
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3a l�• �(ease_ asjiC 4mGAI'Le� I -C-M I'-
d en -�, rv\P- (9,> qlo- 3tf--o - o?o b y.
Reviewer/Inspector Name:
Reviewer/Inspector Signature: C�
Page 3 of 3
Phone: G C�
Date: Z
214a A

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit., Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J64n
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Region:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity PoP, Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pap.
airy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
on -Layer
Calf
Design Current
ai Heifer
D Cow
Farrow to Feeder
ltr, Ca aci P,o P.
Non -Dairy
Farrow to Finish
Layers
rffNon-Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Caw
Other
Other
HEOther
e s
e Poults
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes oNo ❑ NA . ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes Z No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes k� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes %rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: jDate of Inspection: Q
Waste Collection & Treatment
4. fi 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 En 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 6] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [] Yes Z'No ❑ NA ❑ NE
8. Do any of the structures 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 ZrNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
121"N0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L2"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
;"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z 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 JZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of inspection: /i
24. Did the facility fail to calibrate waste application equipment as required by the perjgt7
❑ Yes
O No
❑ NA ❑ NE
i.
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
Callo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
RNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes JZJNo ❑ NA D NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes jZ"No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
JZ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
EjNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes P'No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.,,';
Use drawings of facility to better explain situations (use additional pages as necessary). y
i
1r Al �_•
Reviewer/Inspector Name:
Phone: /a
Reviewer/Inspector Signature: Date:Z.".1.4ellIll
Page 3 of 3 21412011

�1z�ctltty�N�umbcr
Division of Water QUatity' ;' ,t' X, 4)
Type of Visit .Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �� / Arrival Time: 7 Departure Time: County: Region: �-�2
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: Q e = ' =" Longitude: = °
� `a-Lh�# ;+•.}� kS .l7 t1 .F$;
,d..$Designf Current,:, •1:.VL#.:"pesign Current
;x; �_' :.�i,..Jr3cs; �a,.&E. .l.ai,.�.a !. �.a x .>.,.
'Swuael � � '
Division of Water QUatity' ;' ,t' X, 4)
Type of Visit .Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �� / Arrival Time: 7 Departure Time: County: Region: �-�2
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: Q e = ' =" Longitude: = °
� `a-Lh�# ;+•.}� kS .l7 t1 .F$;
,d..$Designf Current,:, •1:.VL#.:"pesign Current
;x; �_' :.�i,..Jr3cs; �a,.&E. .l.ai,.�.a !. �.a x .>.,.
'Swuael � � '
acit i Populuhon
A.kY.:s.. A
Wets Poultry ."Ca acit x Po
,�.:. �.. �.> ta.,e,.•,<�>�.
ulation Cattle '. ttCapacity Population
a ❑ Wean to Finish
❑ Wean to Feeder'
❑ Feeder to Finish
;� : t " ri '"
' ❑ Farrow Wean
i,
gst :( s
asi Poultry
�:
❑ Farrow to Feeder
,Dry , , _ ��
z; a,
❑ Farrow to Finish
❑ Layers
F,
i El Gilts
❑ Non -Layers
❑Boars.
❑ Pullets
❑ Turkeys
El Turkey Po ults
4
Y; 7 �. 9 f e
` ❑ Other
'I ❑Other
;,` Numbor.of Structures ,� k
!7
;.fr
)
❑ Layer
❑ Non -La er
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Doi
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
,.�(No
❑ �I Yes No
❑ NA
FINE
❑ Yes iNo ❑ NA ❑ NE
12/28/04 Continued

Facility Number: ' — Date of Inspection
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ONo ❑ 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 PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ 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 _ON' o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E 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 E3-Ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement'?
❑ Yes ONo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 PNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,[�o [:I NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? El Yes L No ❑ NA. ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes J2"No ❑ NA ❑ NE
❑ Yes La'No ❑ NA ❑ NE
Comments (refer to question#): Explain any YES':answers and/or anyfccommendations or. any other; comments
Use drawings of facility.to better, explain situations. (use additional pages as necessary):
� 2: - Phone:Reviewer/inspector Name Q
Reviewer/inspector Signature: Date: �--
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J 'No ❑ 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 El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Mo ❑ 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 )2TNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ;214o
❑ 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 F No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes,,,O'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes )2<
❑ NA
[INE
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 �o
El NA
El 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
❑ YesNo
❑ NA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
❑
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes o
❑ NA
NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:
2-IL-7
t1le
Page 3 of 3 12128104

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit/V Routine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time. Departure Time: County: h Region: r/
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
__
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator: ' / /e
Operator Certification Number:
Back-up Certification Number:
Location of harm: Latitude: [=] 0 =' = Longitude: a ° =' = "
"
D�esiiggn �. Current
urrent
Design %pu
Design Current
Swine
@opacity Population
Wet Poultry Capacity lation
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
n-La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑Non -La ers
❑ Beef Stocker
❑ Gilts
❑Pullets
❑ Beef Feeder
❑ Boars
❑ Turkeys
❑Beef Brood Cow
Other
❑
❑ TurkeyI'oults
Number of Structures:
❑ Other
Other
Discharses & Stream Impacts
I. 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
ice-'�
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: I?
J--
Date of Inspection L /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struo re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes .ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Jallo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes Z_No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes %WNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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 ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes WNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes W No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes JZNo ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes '0 No ❑ NA ❑ NE
Comments refer to ueshon # Ex lam$an YES answers andlur 'an recommendataons,or xn pother comments' y }
` � $ 5 - 's'� x�i 1 ` I k - }
Usedrawings offacilitj to�better ezplam'situattons:(use itddrtional pal;esas nccessaryr)�.l{�O�gW�, gg��rx �Y
E0.' x y�EY,�.L91, wt IN,
Reviewerllnspector Name -, ' �.
— — �;, `'`; Phone: U" s-70" 3�/['
JA
Reviewer/inspector Signature:
Date: 1 2 /O
12F28104 Continued

Fa;ility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes
Zo
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
21. Does record keeping need improvement? if yes, check the appropriate b below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly FreeboarP12'0
aste Analysis oil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall El Stocking ❑ Crop Yield Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Wcather 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 0[j No ❑ NA ❑ NE
❑ Yes ,!_'J No ❑ NA ❑ NE
)zYes ❑ No ❑ NA ❑ NE
❑ Ycs 6 No ❑ NA ❑ NE
❑ Yes E!rNo ❑ NA ❑ NE
❑ Yes p No ❑ NA ❑ NE
❑ Yes ;'No ❑ NA ❑ NE
❑ Yes [7No ❑ NA ❑ NE
❑ Yes o No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
A�d�dttio al�Coitnrients'an�d/o�r�Dra�s:v
� 3
1. Sezl 14A /elf a s4 Al/
"
L�/
/0//
Al l.
"jo,q
d
�hed
0 SCIO
r
0��s c a1c' k q S J­ 11
e1?«
IVcI/ _fe,
'? �e
12/28/04

L
f Visit compliance Inspection 0 Operation Review 0 Structure Evaluation* 0 Technical Assistance
n for Visit outline Q Complaint O Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 0 Ypeparture Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: IrIntegrator: _
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=' =' = Longitude: = ° =' = "
gent
sign Current
L
Design Current
C►opacity
Population
Wet Poultrypacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Nan -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
-
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Turkey Poults
Number of Structures:
❑ Other 1
10 Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 7No
❑ 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 P No
ElNA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes 06
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Dumber: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes WfNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes VNo ❑ 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 ZNo ❑ NA ❑INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;3No ❑ 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 �Io El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 12rNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ofTNo ❑ 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
V1 No
❑ NA
ONE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5KNo
❑ 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
[f'No
❑ NA
❑ NE
Reviewer/inspector Name F �` � '��� .�>��. � Phone:
Reviewer/inspector Signature: Date:
■ u.5c s vj ✓ �, .

Facility Number• ' 7,.T& Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the approprrate box. P WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
/Yes
❑ No
❑ NA
❑ NE
V Yes
❑ No
❑ NA
❑ NE
w Yes
❑ No
❑ NA
❑ NE
Jz Waste Application pi rWeekly Freeboard 7waste Analysis [Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking iZ Crop Yield V120 Minute Inspections � N[onthly and V Rain Inspections R Weather Code
22. Did the facility fail to install and maintain a rain gauge? / ❑ Yes F-3No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? [Xis ❑ 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 P NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNo ❑ 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
E/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
JZ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
19 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
WYes
❑ No
❑ NA
❑ NE
Additional Comments and/or
//Drawings:
J ,J`
Al
AL
e d� e(W eJfll /teV/
12128104

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A5 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f 1 Arrival Time: 11W Departure Time: I _ h �f5 a„nL County:
Farm Name: _�� { S& Q&rJb "- Owner Email:
Owner Name: _ Oh!(l/NPhone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �SO�IN�y L111fJ�V�`✓
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: —4,6
Operator Certification Number:
Back-up Certification Number:
Region: �Q
Latitude: = o = 1 Longitude: 0 ° = ' 0 "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population C►attle Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dai Cow
❑ Wean to Feeder ❑ Non -Layer ❑ DairyCalf
12'Feeder to Finish c9 O
�! Q
Dry Poultry
❑ Layers
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ NOD -Layers
❑Beef Feeder
❑ Gilts
❑ Beef Brood Cow
❑ Boars
El Pullets
Number of Structures:
Other
❑ Turke s
❑Turke Poults
❑Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ONo
❑ NA
❑ NE
❑ Yes /R1No
❑ NA
❑ NE
12128104
Continued
I'

f
Facility Number: il— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Struct re I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: O
Designed Freeboard (in);
Observed Freeboard (in): 2�1
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 XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �dNo ❑ 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
maintenance/improvement?
❑ Yes /ZNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ONE
❑ 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 Acce table Crop Window ❑ Evidence of MWind Drift ElApplicatio Outside of Area
C,Q
12. Crop type(s) f Lr� 51 i, L�(�%��r� (/t! ✓+-' .
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? 9Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
�ZNo
❑ NA
❑ NE
El No
[I NA
El NE
JZ( No
❑ NA
❑ NE
,;6 No
❑NA
❑NE
10 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendatigns,or any other comments.
Use drawings of facility to better explain situations. (use additional pages. as necessary):
L� � �✓ �FG �J ,�>�
l- !"ram ��✓i K � �%S�L ��D 5
Reviewer/Inspector Name I
,dEj Phone: /U �9� - 3Z'�
Reviewer/Inspector Signature:
Date: %� O
Page 2 of 3 12128104 Continued

Facility Number:31 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NoXFJ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No [I NA [I NE
El the appropriate box. WUp El Checklists Design ❑Maps El Checklists //�-__
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard XWaste Analysis 9Soil Analysis ❑ Waste Transfers ❑ Annual Certification
04-
❑ Rainfall ❑ Stocking*Crop Yield Zd 120 Minute Inspections []Monthly and V Rain Inspections 9weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes f2fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ffNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
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?
Oyes
❑ No ❑ NA ❑ NE
❑ Yes
0 No ❑ NA ❑ NE
ZYes
❑ No AA ❑ NE
❑ Yes ❑ No j2eNA ❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ONo
9fYes ❑ No
El NA El NE
[I NA ❑NE
Additional Comments and/or Drawings:
l� ��f�11C,EO ®rvn/f..�S�fz� /Q�EL°�n/TGy �/'�l?`� A.0 Coe_ 195 Z17
roe_
f_ 4-Z 7 S Z04 A-T6 - - Y04,'
� ChNSa,
to 62z111c__ 41,C100fific,
I
Eml
Page 3 of 3 12128104

Type of Visit CS Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint Qf Follow up O Emergency Notification O Other p Denied Access
Facility Number j'z Date of Visit: I
[Permitted Certified 0 Conditionally Certified 13 Registered
Farm Name: ....._ ...... 1�2 .-Smati-&.gLM......._...............................
OwnerName: _.__ _ _........_..........»..».......................................» »..........
Mailing Address:
R 31 oS Tune:
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold:
County: .._.....•i��p��=i��f,+ . »... .. __...._ .. .
*Phonef a,
FacilityContact: ........_......r.._..........» .............. .»_.».».W.»_ Title: ._» . __..__... _._ _ ..._....._.... Phone No: _... »_.............» »» _ ._...
Onsite Representative:... 4!!Z �ti. .. __ _ .......»..» ............._ ._ ... Integrator..
Certified Operator: ». ». » .»......._ ._....... »_..__.__.......»_ ....»........._ .._..... Operator Certification Number:---_-_._._.-_
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 '96 Longitude • 6 44
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galltnin?
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 l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _ _ .. 1.. ». »_ .. ............... .. _.w....... ,...._ .._ ._..... »_ _ . ___ ._ .._.
Freeboard (inches):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes � N
❑ Yes
ElYes No
Structure 6
12112103 Continued

Facility Number: 31 — Date of Inspection ti 3; 05
5.f Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ENo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [' 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
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ]7NO
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes L11 N
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes j No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type a a-i- VPp C & ) 5 ('-o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [Q No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 1yNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑/h]o
c) This facility is pended for a wettable acre determination? ❑ Yes 12(No
15. Does the receiving crop need improvement? ❑ Yes �No
16. Is there a lack of adequate waste application equipment? ❑ Yes [ NO
Odor Lssues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes dNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes il� o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes WNo
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 No
Air Quality representative immediately.
Feld Copv ❑ Final Notes
an"'_ ?"Aceo G 0Z u6 c; %I 7-6-10
(ac%atJ l.� �lE1. Hh _Cjj (.oc..lE R,rc 41C."(rf CLCUP.
nn,•,, C.R..ZS R tJl KmvA txKe T"
pc rerrv-s� A60
Fofn q=.NG R-ec. 5 l�KkSE;i� GILLS 10 4
,Je'N, o !� EU &T�5 ,
gPE:�S jJE�p T� 4E U3G�tTh{+i .
(15E.
01-i Panva.�__ LAaD
ReviewerAnspector Name
Reviewer/Inspector Signature:
Date: t I A 1 to
1411L/UJ 4onnnu a

Facility Number: I
Date of Inspection I o
Rgguired Records & Document,;
2I . Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need ' provement? If yes, check the appropriate box below.
❑ Waste Application [1 Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Petrnitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes CtNlo
❑ O�zs No
Yes ❑ No
❑ Yes 11 o
❑ Yes [�j No
❑ Yes E! No
❑ Yes fNo
❑ YesNp
❑ Yes No
❑ Yes blxo"o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit.. You will receive no further correspondence about this visit.
12112M3

Facility Number Z Date of Visit: l Y- 13 D y Time: �0
Not O erational Q Below Threshold
© Permitted 0 Certified 13 Conditionally Certified © Registered Date -Last Operated or Above Threshold: ..... _....»..
Farm Name: » '�Assf_r'.......................... County:
OwnerName: _...... »..... » . ._ __ _. _. _ __ ._ _ _ . _. Phone No: ... ........................................................... _.........
MailingAddress:.................».............»............W.......___._._..__........_ ..»...... ___W_ ..... . __» _.. ___.».._.. .»» ......
Facility Contact:
Title:.._ ........................... .___.. _.. Phone No:
Sim
Onsite Representative: _ 'L SRSSE!` __ W_._._W..._... . »...».. Integrator. ._..._rt �R PR .............___._____W.......»
Certified Operator: .. . .... . . . ....... . . . .......... » ._».. _ . ..... _ .» ... Operator Certification Number:.»....».»................:._._.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 'd Longitude • 4 64
Disc es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 01 0
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 S Structure b
Identifier: ___....j ............. ... ..._. _..» ...._ _» ..__.�_.___._. _..... __ .... » _._ . » » _ »» _ _.. _. _ _»__ » .....___•___W_W
Freeboard (inches):
12112103 Continued

Facility Number: 31 —,% Date of Inspection J3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, EJ yes [ZINO
` seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes PJ 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 CfNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes [�N
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
e16ya 'on markings?
Waste Application
10.
Yes
�/1
Are there any buffers that need maintenance/improvement?
❑
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
FNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 9,eg tQ>N C G) S &j
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
91i0
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
iVo
b) Does the facility need a wettable acre determination?
❑ Yes
i
�To
c) This facility is pended for a wettable acre determination?
❑ Yes
a<
15. Does the receiving crop need improvement?
❑ Yes
2<o
16. Is there a lack of adequate waste application equipment?
❑ Yes
Ej`No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes D Na
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes B No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ;o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Field Covv ❑ Final Notes
fAiZnti gAs NaT HAO HO&5 SSnjG� ,•�
33)
�uMPG Cv��►t YJaw^'1c.�*t-V�T►� s-taPs z.j�+ �rrc� sA�s AcJ►v�PEp
aLIT 0to W6r kk P of CoQ-flJ,
ANAL -'-MS tz461
p2G_5 e- 'Y A,JO
di coo C. A N n P ; pu_-S ANT
aw "i c—r -- s -'f_q :r3-j G, T6 6E L. , ,
Reviewer/Inspector Name )t
Reviewer/Inspector Signature:
C.flGoaN 1.0 UAL k-r 19 // R5 kE a r�
f id me 7o 0rSMDj
Date:
12112103 Continued

Facility Number: -5— 2 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. D record keeping need ' provement? yes, check the appropriate box below.
Waste Application 7FFreebaard Waste Analysis ❑Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewfmspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
Yes ❑ No
❑ Yes 2 No
P(Yes ❑ No
❑ Yes 2"No
❑ Yes No
❑ Yes ❑ No
❑ Yes ` 10
❑ Yes ❑ No
❑ Yes M2�o
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number Date of visit: � Time:
I IQ Not O erational 0 Below Thresh Id
Z Permitted UCertifled ©// Conditionally Certified D Registered Date Last Operated or.Above Threshold:
Farm Name: �Ut��°l� SPr' !u'A-r County:
Owner Name: ���"���/ Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No: /
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0& 96 Longitude • 6 0"
Design
Swine Ca aci _
Current aQle'lA!iq
ign Current Design Cur ent
Po Caaci P,o ulation Cattle Ca aci P.o ulation
❑ La cr ❑ Dai
❑Non -La er ❑ Non -Dairy
❑Other
iotal Design Capacity
Total SS1.W
❑ Wean to Feeder
Feeder to Finish
/2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds 1 Solid Traps
❑ Subsurface Drains Present ❑ Lagoon oon Area ❑ Spray Field Area
...........
❑ No Liquid Waste Management System
Di cch ra te► s & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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 Qt[lection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes 9 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes O No
❑ Yes 0 No
❑ Yes No
Structure 6
Continued

Facility Number: 3J —&�g Date of Inspection %
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not property 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 Q9 No
❑ Yes 4 No
❑ Yes EkNo
❑ Yes [RNo
❑ Yes 19No
Waste AV12lication
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN/ ❑ hydraulic Overload ❑ Yes V,No
12. Crop typedn� 12)/ n e:�iPO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ®No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes E.No
16. Is there a lack of adequate waste application equipment? ❑ Yes CgNo
Required Records $c Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ®No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ®No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) R Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ®No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes NNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes IQ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes E No
24. Does facility require a follow-up visit by same agency? ❑ Yes tFrNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RrNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.�', ... -_.. t-.:�ra,.h_......'R3 .�,.��. � � -
Comtnents (refer to question #) Explein,anyrYES.answers' andlor'any4recommendations organ"yotber conitmeatsi i
nz
Use drawmgs;of facility to better explain situations.,(us' addihoohall pages,as�neeessar �] Field Copy El Final Notes
'l9 Awl _/2� 41-11111-he-ffx -C coy ot"'- �'�Q 4e 60'tr"( r��d n> -5 w,°;44 rPeo
�l 41ttO[ 74pLa c�>�c �a�J/ ®{ /s iVKs
47ie ���� Zs w,`f carte P cf rQsa . �GrsnJ carroc� # s
lu 7ir et-� /4/03
ReviewerllnspectorName__.
m •. d � ,�-'fie kxYMsm'm .. I.Z..? an 9,:,-Rk
ReviewerllnspectorSignature: Date:
05103101 /1 1/ Continued
_393 --31 P 0 e4 5-

Facility Number: —52'g bate of Inspection 7
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ;n No
❑ Yes 1!TNo
❑ Yes ® No
❑ Yes n No
❑ Yes b No
❑ Yes 9No
❑ Yes P5 No
Additional Comments anti/nrFibrawingsd.b. ;
05103101
05103101

E ! D1vlSlon Of Watet Q11811ty r e,
Q'DlY15lOIl Of Soll an( Water Conservation
Ulher A gency
t
Type of Visit P.Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit V_Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �Z �/� 6� Tirne: �n Printed on: 7/21/2000
3/
Q Nut Operational Q Below Threshold
13 Permitted 0 Certified Q Conditionally Certified [J Registered Date Last Operated or Above Threshold: ...................
Farm Name: ...... .4g�r.
l4t.! .P.��....�Irz..... l,Cf !,-!..................................... County:.........'%...�t....................................................
OwnerName:..... 41..u.✓.,/.It411.......................£.��c'. .. ............................................. Phone No: ........... ....................................................................... I....
FacilityContact:............................................................... Title:....:........................................................... Phone No:...................................................
MailingAddress: ....................................................................................................................................................................................................... ..........................
Onsite Representative: ....... LQW.O1�°1...................................................... . Integrator:.... xvr !V.......................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:...................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 46 Longitude • 4 «
besn'Cur
Design Current
Deli CMg n ri-eint
-Capacity',.. Po ulanon
Poultry Capacity Population Cattle
ulati6in
Wean to Feeder
AE
❑Layer ❑ Dairy
Feeder to Finish "p
10 Non -Layer ❑ Non -Dairy;..;
Farrow to Wean
,
Farrow to Feeder
❑ Other
yrs.
t:E Farrow to Finish
Total Design Capacity
Gilts
f•'. Boars
Total'SSLW
L �q.� Y4 �f3�- A� �� fir, .,.4, f,t I u
t W,i x �i�lutmber of L Dons
❑ Subsurface Drains Present
❑Leg—n Area
❑ Spray Field Area
�rnj
M. diingPotad
❑iquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galhnin?
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
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
[:]Yes RNo
❑ Yes (SNo
Structure 5 Structure 6
Identifier: .......................
Freeboard (inches): 3�
5/ao
Continued on back

Facility Number: —Lid Date of Inspection !2 0! Printed on; 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 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 X No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ZI No
It. Is there evidence of over application? ❑ Excessive Pondiinng ❑/PAN ❑ Hydraulic Overload ❑ Yes Bj No
12. Crop type T (tea a s-A1 Za,-m v 4 l�,--af e J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Q No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ,� No
c) This facility is pended for a wettable acre determination? ❑ Yes OLNo
15, Does the receiving crop need improvement?
❑ Yes
EX No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
9LNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified Operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspeetor fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
yiQlatl:iOns:o�- dtficjencies v► re pQted' dirririg ttis:visit: Yost will �ee�iye o fulj-t�gr
icorxes otidence: abaUf this :visit.
/n;;' � F rf�:��.,4�,, {`vrTi
Y S answers and/or any_,r r ...,,Yy. , ,...ions:Ortauyw,other com:mentts-' ', . « .r. ♦ * .
Comments refer to uestion # Ex latn an YE ecommendatt
Use dira�rings=af facil�ty!ta better explain situations :{use addiho"nal pages as necessary} : ' i�4 n # t � r � t r
�... ,,. ,...•,• .. M.,
As -Ce-roml& � at Q e r��le <ere 1e�6-w AAxa oA•c �o 7-ee7 'I
Name Reviewer/Ins ector
P V. w 1 � �!/. C J' -' , tM � a rt..+v9'�.ay��3�r,�.''✓.' � 3E7
Reviewer/Inspector Signature: Date: 17,1<1f,41 5100

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes E 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 SNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes allo
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? (Le, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes 18.No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes El No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes SNo
Additional,Comments and/or _Drawings:
a
S/00 `

wti -Yli - I, li
mston of Water Quattty
Fri fa
j
'- i
# �Pt
`"
f
Q Divrsioti of Sot1 and Water Conservation
try a ' xra ' p%!t
44
0 Other A enc hrF
,s rs LY a w
��" " yy„ EMI
X._ t ,
n e•.
,�✓
Type of Visit t_Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for VI sit I,Apoutine O Complaint O Follow up Q Emergency Notification O Other 0 Denied Access
Facility Number Z Date: of 'Visit: { 1 cr Time:: �4 Printed on: 7/21/2000
Not Operational Q Below Threshold
13 Permitted ( Certified [3 Conditionally Certified E3 Registered Date Last Operate or Above Threshold : .......................
Farm Name:
1/t Irl/L l J� . ..!�......Y... County:......... i., ................
.......................... ..... �........
Owner Name: .............. .. Phone Na:
..............
Facility Contact: .... ......1.... ..Y`:...11.`!uV...!:.........�is�+:flitle:.....:..... Phone No :...................................................
Mailing Address: ...........................�.V................ ��r _ ........
f Onsite Representative:, +� ` Integrator: ,M... F
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
i
tL5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' C�` �FF Longitude �• �� 0"
Design Current
Swine Canacitv Pnnulation
❑ Wean to Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 1EISubsurface Drains Present ❑ Lagoa,n Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Imnac.ks
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑Lagoon ❑Spray Field ❑ Other
a. If discharge is observcd, was the conveyance inan-made." ❑ Yes ❑ No
h. if discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. II' discharge is observed, what is tlic ustimated flow in gal/tnin? --V —
d. hoes discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes q
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment'
1
a. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Strut .rc I Structurc 2 Structure ; Structure 4 Structure 5 Structure b
Identifier: ..........�,!...�.......... .................................... ................................... ................................. ........................................ ....................................
Freeboard (inches): 111
5100 Continued on back

I:a cility Number: — ''L Date of Ipspection // i5' a 0 Printed on: 7/21/2000
5. Are there any imme iate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes J�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 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 kNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 9'No
12, Crop type A' ; n I - S
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?
T1o•yiiolatigris:oi- deficiencies were noted• ditring tbis:visitt• Y:ou will•reeeive do further
correspondence.abatiithis visit:
❑ Yes )(No
❑ Yes No
❑ Yes Ikf4o
❑ Yes RNo
❑ Yes Wo
❑ Yes [(No
❑ Yes kNo
❑ Yes qNo
AYes ❑ No
❑ Yes P No
❑ Yes ]YdNo
❑ Yes 'S�No
❑ Yes No
❑ Yes ffNo
❑ Yes E�rNo
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):
I
GGiir '-e6� .
i °� ,.L� _. tu` '"'t Gam. " i,� t: w- .�, + 1u h , CY ==
Reviewer/Inspector Name 6 V (-e K Nit 1 l• l(,t� -
Reviewer/Inspector Signature: , - / Date: J I z�GS/00

Facility Number: — Date of Ittspection 6 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe From the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ 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? Cl Yes VNo
28. Is there any evidence of wind drift during land application? (ix, residue on neighboring vegetation, asphalt, ❑ Yes V0
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes <No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan hlade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes b6o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [Yes ❑ No
7—
Additional CommentS an orDrawings:
a
5100

Facility Number Date of Inspection
Time of Inspection 0 24 hr. (hh:mm)
© Permitted edCertified [] Conditionally Certified © Registered JE3 Not Operat—io—n—all Date Last Operated:
Farm Narne: ......BU.I.. )Z41.1...... .LLS��...f�Q./IJ�..................... County:.......) 1.U.PI1 .............
........................ ......................
Owner Name- ....�&rr l..................... --0--& ................. Phone No �Q ..Z, % —.... .a.!K� ,.
FacilityContact: ...............................4.............................,.............. Title: .......... O.L iq.e.r................................ Phone No:.................................................
j ,r
Mailing Address: ..... .....�I.LG. .S....�✓G.....(.p 0aC1.......................... 7 e7SL..% �1....;...A(......................................Z��,1 �Jr.......
OnsiteRepresentative: ........................................................................................................... Integrator: ....... t..aul'pY.1.t......................p...............................
Certified Operator:. %,
�(ln�.,z5�.,.......... ........ Operator Certification Number: Q -..............
.. �y
Location of Farm:
......................................................................................................................................................... ... ..................I...
Latitude ��• �° �'� Longitude �• ��
Design Current "' '' DesignCu'rrcnt Design Current
Swine •; Capacity Population Poultry ,; .. , , , ;Ca acit ; Po ' elation, Cattle Capacity.Po elation,
❑ Wean to Feeder
IN Feeder to Finish
ZQQ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer I I JONon-DairyjRa'
❑ Other
E Total Design Capacity
�I
Total'SSLW
Discharges & Stream Imaacts
1. Is any discharge observed from any part of the operation? ❑ Yes kNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes N1 No
h. If discharge is observed, did it reach Water of'the State? (II'yes, notify DWQ) ❑ Yes No
c. ll' discharge is observed, what is the estimated flow in gal/min? QJ
d, Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Ye KNo
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes " No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes- [;kNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ....... [.....................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes NNo
seepage, etc.)
3/23/99 Continued on back

Facility Numbg: j 5ZS Date ofinspection-
M_
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes PrNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes JXNo
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 XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
NX No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
KNo
12. Crop type Cogs#a lrr►'11�t� Gra zT_ fit; e.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
4 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
Wo
c) This facility is pended for a wettable acre determination?
❑ Yes
A No
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes [NNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design,0 etc.)
® Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
WNo
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Rev iewer/lnspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
A No
''N6 M1atidiisor• dgfcitrQd• 00irg fhisvisit.• YottWill -tee O: futthO• • : •0: p f.
:: icorresnoncience: a�atit: this visit :::: ::::::... :::::::::......:::
Comments (refer to question #)• lExplam an YES answers and/or any recomm1.endations orany'other Comments ;i '
y
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Reviewer/Inspector Name �. :ifs i TT V,;r
Reviewer/Inspector Signature
;",r fC:;3' ;C1 Q d$ F , ,yuaf .. o
Date: /Z — % _ qq
' 3l23199
q/u) 3#s-SO0 � a�

Facility Nu.rn4r: 31 — 5: A (late of Inspection�-
Odor Issues
NDoes the discharge pipe from the confinement building to the storage pond or lagoon fail'to discharge at/or below es
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ZNo
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 ONo
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 ZNNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
[',�qdi'tional , om.tnellts a[1...30C�
3/23/99

❑
«'C Animal Feedlot Operation Review
r
,fY
NIQ Animal Feedlot Operation Site Inspection
14tRoutine Q Com lai
t Q Follow-up of DW2 ins m!tion Q Follow-up of I)SwC review O Other
Date of Inspection 7ITTI
Facility Number
3�
Time of Inspection � 24.hr. (hh:mm)
0 Registered M Certi
d 0 Applied for Permit © Permitted JE3 Not O eratinnal Date Last Operated:.........
Farm Name: ......................
►he.��.... s..�S. t ...... ..... ... :. County: .......DQoj-................... ......... ....................
Owner Name: .....................
511.11{.r
...... 11c► ........... 11.1.{.1r'.............---..........I.--•---.--........ ' Phone No:....q.A\... ,h..:.&.G.: r.....................................
Facility Contact: ............
.............................................................. Title Phone No:
MailingAddress: ............
�......................................................-:.........................:..................... .. ........... ..........................
Onsite Representative: ..
...........Di)µ{.�.....SN.5ta r/......... ...... Integrator:
„.......................................................
Certified Operator.........
...................................................................................................... Operator Certification Number:...................
Location of Farm:
!^....f 14y^ ....si .
..... o.......51_ 1(o z...' A ...!!h! �...... r d� ... ...9..... 1 as e.... I-Ail.:................................................................................................
r
._ ...
..... ................................................. .. .. ..
T
Latitude �•
' �" Longitude'
Design Current Design Current ;; Design Current
$wine
apacity:Ypopulation . poultry. Capacity .Populatron , Cattle Capiactty Eopulation
❑ Wean to Feeder
JEILayer I I❑Dairy''
I�jFeeder to Finish
by .- ❑ Non -Layer El Non-Dairy
a° ❑ Farrow to Wean
El Farrow to Feeder
❑ Other
Farrow to Finish ❑
Total DeMp Cipa kj;,
M ❑ Gilts
❑ soars
Total SSLWJ,
7, H y .:.
7.
777
7 Number of Lagoons / H ldmg Ponds r ❑Subsurface Drains Present © Lagoon Area ©Spray Field Area
;t ❑ No Liquid Waste Management System
..
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
2.
Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge. is observed, was the conveyance man-made?
❑ Yes
Ep No
b. If discharge is observed, did it reach Surface Water" (if yes. notify DWQ)
❑ Yes
NNo
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
V No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
6 No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
M No
5.
Does any part of the waste management system (other than lagoons holding ponds) require
❑ Yes
19 No
Mai n tenan ce/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures _(Lafoons kliol_dintr Pond, Flush Fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Identifier:
Freeboard tft): ...... ..... 1_4............. ...
❑ Yes 1�4 No
❑ Yes %No
Structure 2 Structure 3 Structure 4 Structure 5 Structure t
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.'Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP,1_or runoff entering waters of the State, notify DWQ)
XVia+................_x.�4ru!�......i� - An...................... 15. Crop type ...................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a 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?
40* 25. Were any additional problems noted which cause noncompliance of the Permit?
[3 No.violitions•vr. deficiencies were-nnted-ditring this;visit.• .YDit.will receive izo.ftirther',
•�.-correspondenceab:autihis'.visif.•�,�� .-� : � �•:•�•:•�.�:•�..��.���:•••����� �.• �•.-�.••.�.:. ::.-::.:.�.
❑ Yes No
❑ Yes No
CRYes ❑ No
❑ Yes No
❑ Yes 19 No
❑ Yes M No
❑ Yes 1A No
Yes ❑ No
❑ Yes M No
® Yes ❑ No
❑ Yes No
M Yes ❑ No
❑ Yes 1A No
❑ Yes 1 No
❑ Yes No
12. Gvt,-,zz6'K aarc0..14 o�. o,,4, JtV, w►(l 5ko-A� 4- m5eJej. &ma._L s 1,0oid (a� �
Q, uQ,Yr+'�U�.p� li'l 411, �-rcS M.u51' o� i Mi�yjyJ[e)� Co'k�.t co"A� .%X�+U, ky" or 6z%�rzcv
5'a�1 S- WkL, 6r A45i5 e. ft pp
tt. �C S��vrrr�i I'RiZ-� 51tiaA 1 er 14 �� e�c� �fe�� U1,-) � Caryr-cf PAW 6-v
1, � S1 \000 6e_ v aaW � „�
l�1 v1\ , We s l •t � S ci � satn�+ �► dari 0)¢ g'Tk � r Vti-4i tat ow, 4'--
6� Paw po r- o(j io soo,, ty,- ►-i CajS-
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: j�,L_____ / - /rf Date:

0 Routine O Com laint O Follow-up of DW2 inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection q'I
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status- -Registered ElApplied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated : ............. ..................... ....... ................... ...... ....................... ...................... ..... ......... .......... .......
Farm Name:.. �?. f t .�.....�s,...l s !r... .:.`�.`.............................. Cou nty:..P. u.t.A.'t).................................. .i.T
LandOwner Name:........V.:!..x.?::,N.... ... ..................................... Phone No:...... i.0..........R!A: ..........................................
FacilityConctact:.................................................................................. nTitle: .................... ........ .................... Phone No: ..................... _.................. .................
q
Mailing Adclress:........?Y:.S....5 .. 5..... .......... .....
0.5.........i...*...................Z.....i.ra.o
OnsiteRepresentative:............................6............. Integrator:....t"t.v. ..................4.....,,....G........................
CertifiedOperator:................................................................................................................ Operator Certification Numher:....1.11 r.T..) ....................
Location of Farm:
General
1. 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 Watct? (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)
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
4/34/97 maintenance/improvement?
❑ Yes C.No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
❑ Yes
; No
❑ Yes
Iff No
❑ Yes
RNo
❑ Yes
RNo
Continued on back

Facility Number: ...3.1k...... �...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IN No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ,9 No
8. Are there lagoons or storage ponds on site which need to be properly closed? Yes ❑ No
Structures jllagoons and/or Ilolding .Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes �Vo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
. I .............. ............................ ............................ ............................ ............................ ............................
10. Is seepage observed from any of the structures? ❑ Yes &No
11. Is erosion, or any other threats to the integrity of any of the structures observed? 19Yes ❑ No
12. Do any of the structures need maintenance/improvement? 0-Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ® No
Waste
Apalication
14.
Is there physical evidence of over application?
❑ Yes
®.No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crap type ......... ...... Y.K.....................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
allo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
allo
18.
Does the receiving crop need improvement?
❑ Yes
B No
19.
Is there a lack of available waste application equipment?
❑ Yes
18 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
9 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
For
22.
Certified Facilities Only
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
J9No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E9 No
24.
Does record keeping need improvement?
It Yes
9. No
Reviewer/Inspector Name V M
Reviewer/Inspector Signature: Date: 2
cc: Division of Water Quality, Water Oualitv Section. Facility Assessment Ul 4/30/97

Site Requires Immediate Attention: i»
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT.
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. r0 / , 1995
T Time:C�
Farm Name/Owner: t r' s-s z.-t
Mailing Address: S*uvta `72J 0& H l yl ( a <645-$
County: '
Integrator: Phone:
On Site Representative: Phone: a '6 `� - `t U 3
Physical Address/Location: S:� I I o a 3 +.,.,; i Zs •1u„
s
Type of Operation: Swine Poultry Cattle�.�
Design Capacity: I a Oy Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard'' 3 Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? YY or No Is the cover crop adequate? - Yes or No
Crop(s) being utilized: Co t,� ,�..,� C 0 O A-C
•
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 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 No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
.spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: So_I+' 6 ' sA� . L cAs ',.7, qh-,� i ado
L_
cc: Facility Assessment Unit
Use Attachments if Needed.