310536_INSPECTIONS_20171231

�Vn
NORTH CAROLINA
Department of Environmental Qual

Type of Visit: U7Rou'line
nce Inspection U Operation Review U Structure Evaluation Q Technical Assistance
isit:
Reason for VO Complaint 0 Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: ArrivalTimed lol9D Departure Time: 1 r County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Ousite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine CUpac
et Poultry
Capacity
Pop.
Caere apacity Poim pp
Wean to Finish
La er
Dai ry Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , Poutt
Ca aci
Plop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
RL
Beef Brood Cow
Turkeys
Other
Turkey Poults
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Othe
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Other
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Discharizes and Stream im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
E2N0
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
rxo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili N mber: IDate of Inspection: q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): IV
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes F717No ❑ 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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [Z'? o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
❑ Yes ❑ No ❑ NA NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes ❑ No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
1 S. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NAjNE
N
0 Yes ❑ No ❑ NA E
❑ Yes ❑ No ❑ NA
❑Yes ❑No ❑NA
❑ Yes ❑ No ❑ NA
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA
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 eNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections ❑ Siudge Sur4/E
ve 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili tuber: - Date of In eetion: ZS /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑-NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA �IXE
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 [DNA 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
❑ No
❑ NA
NE
permit? (i.e., discharge, freeboard problems, over -application)
3I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
ICJ 1Ve
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑
❑ NA
NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on representative?
Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�Noo
C] NA
❑ NE
Comirie'nt8 refer€to uestion Ex [aini'an' iVESlanswers`andlor an . additional'"recamiiiiendations or'an 3otli'ereomments.141, `, '!
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Use'drawin s of facih to better. ex lam3situatiops use addihana'pages as;necessa
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Reviewer/Inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
2PI 4 — 0e r M, -F j ) t.('n t, -14� /a
9
9JC- kW 5 �n 5.4CCf,Vn. A-eP L-`f4' rtirco'c4S.
9 10 -;;"1 b
Phone: WIM
Date: - I tz,
21412015

type m visit. V t.,ompnance inspectiun v uperation review lJ structure r,vamattun kJ iecnmcai Assistance
Reason for Visit; 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 Arrival Time: Departure Time: County: Region:
Farm Name: �t Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
I
Facility Contact:
Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish _L[La er
Design Current
Capacity Pop.
Desigu Current
Cattle C*apacity Pop.
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Ca aeit Po
D Cow
Farrow to Feeder
Dr P,oultr,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 ❑ No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: jDate of Inspection:
Waste Collection &'Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑.Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
[]Yes
❑ No
❑ NA
❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' parture Time: County:/ , Region: L=�
Farm Name:
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: 10� / �► Title: Phone:
Onsite Representative: Integrator: A4/'o
4 If
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design @urrent
Swine Capacity Pop.
Wet P.ouitry
Design Current Design Current
Capacity Pop. C►attic Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Dairy Calf
Wean to Feeder
1
INon-Layer
I
Feeder to Finish
Farrow to Wean `
Farrow to Feeder
D . P,oultr
Dairy Heifer
Design Current Dry Cow
Ca aci P,o , Non -Dairy
I Beef Stocker
Beef Feeder
Farrow to Finish
Layers
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
"Turkeys
Other
Other
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 JZ No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes J2�'No ❑ NA ❑ NE
❑ Yes �No
❑ YesT�io
❑ Yes T�
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is 9.orage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
P ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes T,,bNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Rio
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yeso
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA
NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, ete!j"_
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes p-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes C; "'o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes U71-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes P_NO ❑ NA ❑ NE
Yes O-N`o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes'0'_No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D-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. I ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONO
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P340
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes',❑ -No
f
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes .[�rNo
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 .E�'Ro
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,D 'No
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,
34. 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 pen -nit 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?
Comments (refer to question #): Explain any YES answers and/or any additional recommei
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes _Jallo D NA ❑ NE
❑ Yes 13'No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes )2'Mo ❑ NA ❑ NE
❑ Yes [3"No
❑ Yes ��o
❑ Yes ❑ No
or
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
lud lot/95- ,
j //aj 1,70k
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�ly
Date: l2
1141261

Type of Visit Q�Ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Ti 7 Arrival Time: Departure Time: County: 4"Regione __ S
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: _
Facility Contact:
Onsite Representative:
Certified Operator: —
Back-up Operator: _
Location of Farm:
Title: Phone No:
Integrator: ^� la a_ z
Operator Certification Number: �t tea,
Back-up Certification Number:
Latitude: 0 0' =" Longitude: 00 [=. ❑"
a a.sf.
Y . _ ,Deng°,. eurrent 'g c z, 3ti»t' .t ,:Design",] Current . ^� y '.Ues�gtr> s Cu.rre,nt}sA'.
Swine:4 Capacity , Population ; SN'et"Poultry ` Capacity}Pbpulation�Cattle4:�C� 'gcity'Populataon,
❑ Layer [] Dairy Cow
_ ❑Wean to Feeder ❑ Non -Layer ❑ DairyCalf
} ❑Dai hei
❑ Farrow to Wean fer
�t Dey Poultry I` yi' e s Z x El Dry Cow
a
`'❑Non-Dai
_ ❑ Layers
❑Beef Stocker
❑
❑Pullets
❑ Soars ElBeef Feeder
❑❑ Beef Brood Cow
Turkeys
- .•,
_ ❑ Turke Poults < �4 $ft
❑Otherill ❑ Other Niirnber aStructures
Layers
El
Non -La
��
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 I of 3
❑ Yes V1 No ❑ NA ❑ NE
Cl
Yes �No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
12/18/04 Continued

Facili Number: jDate of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PNo ❑ NA [] NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �^No ❑ NA ❑ NE
(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 ZNo ❑ 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 .7INo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;�J_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 P3"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?
7,No
11. Is there evidence of incorrect land 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 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):
U. 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 ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �2rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P?No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes VNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
_VNo
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ONO
❑ Waste Application ❑ Weekly Freeboard Owaste Analysis ❑ Soil Analysis 0 Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4� No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 551,0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: j I jDate of Inspection:
2T 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 LD"No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes f!fNo
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ro ❑ NA ❑ NE
❑ 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 an other comments.
Use drawings of facility to better explain situations (use additional pages as necessa ), ,;,
A_) 1 xle 1,ec,9,,X � r
(901/2
G.9" Z•�G � �cf2�ly��r ice
z e�
AJ� al?O11911,f Q T v radl 6d
-�� eae.7A ryn
P C�UP62�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
66,S
o'Q C
Phone: 9 6- 7V34
Date: 2 117le—
t/ 011

Date of Visit: I/,,t/7/// I Arrival Time: Q eparture Time: County:
Farm Name: Q ( `'1QI, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: U jo�K&/ 4 �5'-n
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: of lz5
Certification Number:
Certification Number:
Longitude:
Region: zd�
Design Current.
Capacity Pop
Design Current
i�et Foiiltry C pa ty Pop..
Design Current
Cattle. Capacity Pap.
Swine
.R
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
3i. Design Current
DryFow
Farrow to Feeder
D .oultra ,Ca aci Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
ISO
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE_
l
C
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes WNo
❑ Yes �No
❑ Yes 211�0
❑ NA ❑ NE
❑NA []NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection: a Z714
Waste Callection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C2'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ZNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes C2 No
❑ NA
❑ NE
waste management or closure plan? T
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 ,E]"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 [�o
❑ NA
❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;'No
E] NA
❑ NE
maintenance or improvement? %
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;].14ro
C] 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
[
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
T�rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
R'Ilo
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
;Z o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
�o
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes La
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ 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 V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes � o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes YNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,E!rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E '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 J21'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P No ❑ NA ❑ NE
Other Issues 7
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E 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 E!fNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ],No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes T ErNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ 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).
P .,54ar dd 1A 1-rj10-�Cq-11 1-eecv.�'-1
Stele ad S.,/ -le
WW1P1 y 4is f
Y
Reviewer/Inspector Name: lie
Reviewer/Inspector Signature:
Page 3 of 3
(AJ r r 17eeal /-6 cla x oluotre
4-P d c'f" 1 e xi -A /o ` � [-j !t /
`i/l e Lk v n 1-hu
Phone:
Date: ;7
/4 Il

IType of Visit JQ'Gmpliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit routine O Complaint O Follow up O Referral O Emergency O Other El Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Time: Departure Time: County:
` Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative:ALE integrator: Aop
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: c ❑ ' = Longitude:
Region:
}..; Xt i`� s°s'':18;m kaki a
Design Current �'•. 4 . yT,Des�gn'g Currenf�� its} DesignCurrent,
Swtrtc' Capacity 'Population b Wet f?oultry`�.�-';Capacityp;PopulatiCattle �CapaqyPopulateon
❑ Wean to Finish . ❑ Layer
❑Wean to Feeder ' ❑ Non -La er
❑ Feeder to Finish`'' + t , ' ^ , .
v ,.
❑ Farrow to Wean tt'�a_a.�4�
IDry Poultry,
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
❑ Boars
777 f <t
Otherq� _
11 - s h.^
. t sa
. ❑Other tuber r ,
�: .•. f, ....v,. s:',".s,,e: ',i��„, 'fe:5�:e':�e "��i:��i�..��F�,R��a;��,� 58k��; � �� �,��
N u rye
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TiTurke Points
❑ Other
❑ Daily Cow
❑ Dairy Calf
❑ Dairy Fleifer
❑ D Cow
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Discharges & Stream Impacts
I. 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 l.d No ❑ NA ❑ NE
❑ Yes
❑ Na
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Ld No
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
12/28/04
Continued

Facility Number: Date of Inspection[ZZ4
..Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 62
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes PNo
❑ Yes ❑ No
Structure 5
El NA El NE
❑NA El NE
Structure 6
❑ Yes [ No ❑ NA ❑ NE
❑ Yes V(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
�Y'1'o
❑ NA
ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
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 altematives that need
❑ Yes
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L QNo
❑ 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
f[ No
❑ NA
El NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
)?I No
❑ NA
❑ NE
_ . g :: -. _ _ .. :., a '. .� ,.ar," t >.. • f r :��a i �H� �'�� �
Cort�ments'(refer to;question;#)$ Explain any YES answers andltir anyrecommendations or airy other(comrnents r >`
Use drawmgs,of facility to beiter-explam situations.,.( use additional pages`as necessary) :
ar�j'd [ Reviewer/inspector Name
Phone: ^
F ,;3:
Reviewerllnspector Signature:
Date: 2
Page 2 of 3 12/28) 64 1 Continued

Facility Number: — Date of Inspection y
R_ectuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
j2rN0
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[;Ko
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9'fio
❑ 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
P"No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ Flo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
WNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
AddlHonal Comments and/or Drawings:
6 e� ,Su
-J, u lew;
'rw,m fewo-115 5
12128104

IType of Visit C Ifompllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Op6utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name:/ /� l l r trl Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: fJrnG�Ip`� O�: taw_
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator: Z4_-. Ile,
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: ❑ o = = 11 Longitude: = 0 =' ❑
Iil
Design Current
Design Current
REPO,
Swine
Cpacity
M
Pounpypuatlon
:,
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑ Non -Laver I
ai Calf
❑ Feeder to Finish
airy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
Pullets
❑ Beef Broad Cow
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[;^o
❑ 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
,Z No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[2<o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 E'No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 6No ❑ NA ❑ NE
❑ Yes 2No ❑ 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EfNo ❑ 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 Rlo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
GNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El[ Yes
INo
❑ NA
❑ NE
Comments {refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Phone:
Reviewer/Inspector Name,<° ;urn �� ��,%•; ",�;a 7/�fr,S"�g- 3,r✓�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

,Facility Number: �T Date of Inspection
Renuired Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �DRo El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [I Yes [3 No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5?No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z_No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5'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
❑ NI
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[?I�o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�lo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VfNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�'No
❑ NA
❑ NE
Additional. Comments and/or"Drawings ::;.j, :
IV
%� �
�
4
w rQ
7/2- 21,V
4/
45 _e"�- -JOVA C-%
Q Jr— C
jo
wa� Uctd-.
Page 3 of 3 12128104

Factltty Number 13 S3G
.015,1
vislon of Water Quality:
Q Division of Soil and Water Conservation,
Q Other Agency
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit AlRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: l C�2f 1 Departure Time: County: r Region:
Farm Name: Owner Email:
61
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Ll�i1//CrTC4 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: f f o
Operator Certification Number:
Back-up Certification Number:
i u ❑o =` ❑tt
Longitude:
Design Current Design Current
Swrne; 71. Capacity Population Wet Poultry Capacity; Population
❑ Wean to Finish i ❑ La er
❑ Wean to Feeder ❑ Non -Layer
eeder to Finish 01
❑ Farrow to Wean Dry Poultry,:
❑ Farrow to Feeder
❑ Farrow to Finish j
❑ Gilts
❑ Boars
;< Other
❑ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity;. Population
❑
Daia Cow
❑
Daia Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 2TNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[I Yes
No
El NA
[I NE
❑ Yes
RO No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 „
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier:
Structure 4
❑ Yes ErNo
❑ Yes gNo
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):,2 r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes /6 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes F No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes CxNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 >o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other. comments. '
Use, drawings of facility to better explain situations. (use additional pages as necessary):
w
Reviewer/Inspector Name j Phone: l - 'Ilk— 7���
Reviewer/Inspector Signature: Date:
Page 2 of 12178104 Continued

`facility Number: — Date of Inspection D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 9120 Minute Inspections Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
PTo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
gNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No [a NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No P NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [;YNo ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes [--]No
❑ NA
I�WE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ,❑'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes�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
❑ YesS
El NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes J:I•No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes .0'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
- /7
Page 3 of 3 12128104

Type of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation j
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other p Denied Access
Facility Number = Date of Visit:
Permittec�*ertified © Conditionally Certified Q Registered
Farm Name: ..... I tl G� ,� ........G�IC
Z2 Tune: 1 5P e
Not Operational O Below Threshold
Date Last era d or Abo a Threshold: ... »........ ..........
County: .. »_......... _. _ ..w_.__._..
OwnerName: ......... ...................... .....................__........-----......---------......---..._..--- 'Phone No:
Mailing Address:
FacilitvContact: W _ .._ .._ ...._� _j_....~�_ _._ _. » »»Title:.. »....._..»..»»...................»........_ Phone No: » ..» ........ ..._.........._.,
Onsite Representative:..((�.I� �&�! / _... .. ». _» ..... Integrator:
�.I
Certified Operator: ........................................... ... ...... .... ...... ............... Operator Certification Number:—._----_-__
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 Oct Longitude • 4 44
El Wean to Feeder
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
n Boars
,Desrga Current rDesign - urreat E
ry i.. Al cinacity" Tonuflation :.Cattle ;Capacity: = Ponnlatiorei'.
❑ Layer
Dairy
❑ Non -Layer
"'
Non -Dairy
Other,
iTotal
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?
==Tota1'S
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?
❑ Yes jErNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Zfio
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )aWo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,j!fNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: »». __ __�»_... . _ _. _. .._.__ ..... _ . ........._... _ ._..._. ......»......».......».» . ».....» ....».»
Freeboard (inches):
12112103 Continued

Facility Numbers — Date of Inspection
5 : Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes ANo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes )ZNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
�No
7. Do any of the structures need maintenancelimprovement?
❑ Yes
B. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes P 110
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 2:�No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes�No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes n No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes El No
b) Does the facility need a wettable acre determination?
❑ Yes 2No
c) This facility is pended for a wettable acre determination?
❑ Yes 'a -go
15. Does the receiving crop need improvement?
❑ Yes 2'No
16. Is there a lack of adequate waste application equipment?
❑ Yes 2No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ;2No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes El"No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Erf4o
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 [moo
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
f /CJC.S2 Cp�T�'i?1.C��i 740 Gt/C ems
el�
Reviewer/Inspector Name X
Reviewer/Impector Signature:
Date: '7/? q /d
12112103 Continued

Facility Number: — Date of inspection
r
e uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,0 No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes P40
23_ Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ No
❑ Waste Application �reeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 01] o
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes Zwo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? [:]Yes ONO
28. Does facility require a follow-up visit by same agency? ❑ Yes,,rNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes)zlqo
NFDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes pl�o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit $t Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 9f Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of visit:
Permitted 0 Certified [3 Conditi=111 Certi/fied % 0 Rd ssttered
Farm Name: - / r,-,&_ l'r,1
Owner Name:
Mailing Address:
Date Last Operat or Above Threshold:
County: t y�zx
Phone No:
Futility Contact: Title- hone No:
Ig
Onsite Representative: FM �� �� Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry [:]Cattle ❑ Horse Latitude ' 6 0 " Longitude 00 � � 64
Wean to Feeder I I 111LJ La e
Feeder to Finish I I IM Non -
Farrow to Feeder LI Other
Farrow to Finish
Gilts IEHI�
Subsurface Drains Present
o Liquid Waste
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes 40 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes XNo
Structure 6
Continued

r
Facility Number: 51 —b'3 Date of Inspection
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?
(If any of questions 4-6 was answered yes, and the situation poses an
❑Yes
No
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
/16 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Exc live Pondin ❑ PAN Hydraulic v rload
❑Yes
XNO
12. Crop type i�%� L aifzSer,
13. Do the receiving crops differ with those designated in -de &rtified Animal Waste Managemen lan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
../No
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
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
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
X
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?
El Yes
1
21. Did the facility fail to have a actively certified operator in charge?
❑Yes
I
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
�,�+
(ie/ discharge, freeboard problems, over application)
El Yes
(_Q No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
/No
24. Does facility require afollow-up visit by same agency?
El Yes
(�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
/VNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.,d�'+i► +ems 3* - ,.�: .•:. ,•.- :� .. -.• '..x �n r?� z. .. ,ti
,.,_., +. uestionttiO)Expl
Comments(refer-to ; qain any YES answers and/or,any recommendations or any o er:cumments =,
R k, ?R.� "€ i-an .-=.,ea t 1yi
Use i3rawin �s ofafacility to better lain situations (use additlonal;pagestas necessary}
r 6 gx
, : Field Copy ❑ Final Notes
..
IDS Eo on�reo�
,6,54Co Z�,� 42,PwO4�2 E
-o
z9o'v"). ��c G,Bzczor �Suc� �s
2�
Reviewer/Inspector Name �-
�'"
Reviewer/Inspector Signature:
Date:
05103101 Continued

I Facility Number: 51 Date of Inspection
Odor l[ssues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
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?
El Yes [�(No
I
El Yes
N El Yes No
o
El Yes KN 0
El Yes o
El Yest'�NO
[:1 Yes [I No
Additional Cornments aifd/6-f MaWhigs:-'
A1'P'q 202- z>n 2-
EkZ 17 V
lee 01 /0;;/e L51-46C C
APL-:2
P 1C
05103101

,, i
Division of Water QualEty
wision of Soil antl Water Conservation
a
O'Other Agency. ;
Type of Visit Q Compliance Inspection Q Operation Review O Lagoon Evaluation
1.
Reason for Visit R Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number jf
Date of Visit: 2 D Time: ® Printed on. 7/21/2000
3��
Not Operational 0 Below Threshold
® Permitted ® Certified /❑ Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: °r �! �l J!Al... County �. t....................................................
.......................
�!�...... ...........e44.. e......................................................... _ • ......... .... e);'et
OwnerName: ..... b),?n+�Nltr........................................................................................ Phone No:.........................................................................
FacilityContact: ....................................... .......................................Title:................................................................ Phone No:...................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative.....OWMY�................................................. ........ .............. Integrator:.... kt!f. .hy...L.!4e.l. f .. Q✓ems
Certified Operator: ................................................... ............................................................. Operator Certification Number:.................... .................
Location'of Farm:
❑ swine ❑ poultry ❑ Cattle ❑ Horse Latitude • & 46 Longitude 0 6 «
.', ' ... Design Current
Ga aci Po uh8tio
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Current
Poultry Capacity Po uladon Cattle
❑ Layer ffion-Dairy
airy
Non -Layer
❑ Other
Total Design Capacity
Total SSLW
esigrt Current
❑ -;Field Area
Subsurface Drains Present ❑ Lagoon Area ❑ Spra
f �Y !
❑ Ni
o Liquid Waste Management System
Discharges & Stream Impac
1. Is any discharge observed from any part of the operation? ❑ Yes D9 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. II'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 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes UNo
Sti-UCtUre I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

r
Facility Number:,; Date of Inspection Z
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 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 U&No
_Waste Aaolication
10, Are there any buffers that need maintenance/improvement? ❑ Yes RLNo
11. Is there evidence of over application? ❑ Excessive Ponding q PAN ❑ Hydraulic Overload ❑ Yes ELNo
12. Crop type lSv✓�rlulft lfmcrt� /Sifasl� G�sl� CG$'ccl' )
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0;. 1Q yi 1p i�jtgs'o d fc�e cies -wore no(jed• doiog Ns;visit; -:Y:oo 30 -t iye o fu>j-t $r.
• �rorresoorid6& about: this visit: :..:.:::::....:................... .
7�r5 4Aw- 4,je_-
❑ Yes R9 No ,
❑ Yes 91 No
❑ Yes JZ No
❑ Yes IN No
❑ Yes ® No
❑ Yes M No
❑ Yes R,No
❑ Yes [(No
❑ Yes EQ No
❑ Yes %No
❑ Yes K No
❑ Yes Q No
❑ Yes 9[ No
❑ Yes El No
❑ Yes ® No
whrr�
Reviewer/Inspector Name'; �� �d
l
A.
Reviewer/Inspector Signature: ±Vk_e e, Date: /z //3 /D/ S/pp

f
Facility Number: — Date of'] nspection 2 Printed on: 7/21/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [A No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 5J No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [5 No
1:40ditionall Comments and/orDrawings:
AL I
5/00

? ... ,pT .- 1 I t :.6, ��)'j `fly•. 15.j! i -
Ii�IS1011 of'. ►later
E 1 i" -_ S �}'w5F
'•t.e
i I 11 5
.
4 k't i N1�r}
k ' t
Divrston of Soil and Water Conservation
`i', r�, s�* , 1
rU l c j
Other A enc �, :
O g
�
�k 1 ,,� «?u r
Ffi l
S_..k
y: a
Ctrs
a,� y � d� _Ut,. m :` �I �� �' �'�'^`ruFr• r `s
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit >(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
3 [)ate of visit: �{? 7� GQ Time: + b Printed on: 7/21/2000
Facility Number
XC
771
QNotO erational O Below Threshold
Q Permitted ertified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ....
Farm Name: ...........�'.... 1.4.�! Q ......� ` County:........... Lf..............................f.l`......
Owner Name: .........[.�................ �G `........................................... Phone No.......!.f.�.,.... .....g.3..'....... 2-0.....................
Facility Contact: .............................................................................. Title:........................ Phone No:
...........................................................................................
MailingAddress: ....................................................................................................... ..........................
Onsite Representative:} �, �� �I i. @�eG. Q Integrator:........................................................... .....
Certified Operator:................W.�I.....I.�.1-.eV Operator Certification Number:...Z.�...3........
Location of Farm:
T..I
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �' �= Longitude •
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer JE1 Dairy
Feeder to Finish III ❑ Non -Layer JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lag..nn Area I0 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System .
Discharges & Stream Im acts XNO
I. is any discharge observed from any part of the operation? ❑ Yes
Discharge originated at: ElLagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the convcvanc�; ratan -made? ❑Yes ❑ No
b. If discharge is ohserved, did it reach Water of the State? (If yes, nitrify DWQ) El Yes ❑ No
c. II' dischargc is observed, what is the Usti€natcd 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 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Su cturfy I Structure 2 Structure Structure 4 Structure 5 Structure 6
Identifier: .......... ................... .I.......................... ........................
Freeboard (inches):
5100 Continued on back

Facility Number: Q Date of Inspection ® Printed on: 7/21/2000
f 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yeSNo
seepage, etc.) >(
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �Vo
(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
XVo
//1
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
ElYes
0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
Waste cation
_Appl
10. Are there any buffers that need maintenance/improvement?
❑ Yes
eyNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
)<No
12. Crop type
13. Do the receiving crops fifficr with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
10
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�10
//❑
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
X No .
16. Is there a lack of adequate waste application equipment?
❑ Yes
o
Required Records & Doeumeeits
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�Io
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
r
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
KNO
19. Does record keeping need improvement`? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
ElYes
VN0
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ic/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
o
24. Does facility require a follow-up visit by same agency?
❑ Yes
o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
.10 violafit?ns or deficiencies W, re noted• d,tiring � , is:visit! Yon will �ece�ye tio: furthk:
•.orres� onc�ence:a�otit:this:visit:''�' .•'• '''-'''-''-.• '•'•''''.'.•.•.•... .. .
Comments (refer to question Ii): 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):
L
IV

Facility Number: 3 f - Date of Inspection Printed on: 7/21/2000
%Y Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or bielow ❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes a
28. 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) Ir
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes o
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 1—�;6o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 1Vo
Additional:C'omments and/or Drawings: I
Ak
w
5/00

13 Division of Soil andWaterConservation Operadv R eview r
`
S 4
Dlvrs%on of Soil and, Water Conservation Com ha c
0 nee Ins ection j
1�
¢ i
w�
t
S
i
r .." o-yE 4 E E 1 E s ¢. ;ti , „i9il 3 I i!
Y i iliha '�, -' Ek i fr { h7
Divisionof Water Quality=Compliance Inspection ,
is .:
-_.�.i.u.>�
F
Other A enc ='O eration,Renew ,..
,. -. .. .f•.. ..... ., `: t.a Vtv z g k Fi@,:� ii',. ,
l-I a,J 'i.;;
16 Routine O Complaint O Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other 1
Facility Number Date of Inspection 111 1ZC1/71 1
Time of Inspection 1 Z 7_577 24 hr. (hh:mm)
[3Permitted ® Certified 0 Conditionally Certified 0 Registered JUNot Operational Date Last Operated:
Farm Name: wen L#. TPCe e ��Y,� U tP.. t'�.......................
'.................... C.ounty:........uf................................................ ........... ...... .T�tc
OwnerName: ..............................._1...................................................... Phone No:.............................,.,...................................,...................
Facility Contact:...........................:.................................................. Title:................ Phone No.
MailingAddress: .......................................................................................................................................................................................................... ................
-Te�..�'..�/Fq Y I
. Integrator:. ..17.T`' SOnsite Representative :..............� ......
J........................................................... r .................
Certified Operator:................................................................................................................ Operator Certification Number:......................
Location of Farm:
.......... ..............................................................................
........................................:..........:..............................................................................................................................................
.... .. .......................... ..... w
Latitude • ` " Longitude • 4 Li
Design Current :, , , ' .. Design ; ' Current' , Design Current
Swine h '' tioPoultylation Catle CapacityPo ulai Capacity Po ulation
❑ Wean to Feeder
Feeder to Finish
! 2_4)0
1 a.
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
,
Total Design Capacity
t TotaI:SSLW
Number of Lagoons—; ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Ares �`
0,..
Holding, Ponds / Solid Traps E= t ❑ No Liquid Waste Management System
'E
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes X No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made,? ❑ Yes 99 No
b. If discharge is observed, did it reach Water of the Stale? (If yes, notify DWQ) ❑ Yes H No
c. If discharge is observed, what is the estimated flow in gal/min? ki
lq
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 2q No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes B No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ER No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard(inches): .........3ri..........................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes :In No
seepage, etc.)
3/23/99 Continued on back

Facility Number: ":3 --�3� Date of* Inspection
6. Are dhere structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenatice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type 13-arrvrud-t G�'�iZe�-�r`'"I�� 61-A 't
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?
Reuuired 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?
❑ Yes it No
❑ Yes Xf No
❑ Yes X1 No
❑ Yes §6 No
❑ Yes 1f No
❑ Yes 9 No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes No
1D Yes ❑ No
❑ Yes 91 No
❑ Yes M No
❑ Yes 81 No
❑ Yes 09 No
❑ Yes C?No
❑ Yes Dg No
❑ Yes 9 No
❑ Yes No
❑ Yes No
❑ Yes 2SNo
0 10 v161atioris :or• ifefie ncies ire itgte0. stirring Ois:visit, • Y:OI} will •reegiye fi cui-thgr... I
corres orideirce: aN k this vesit. ::: : :
Comments (refer to question #) Explain any YES`answers ariWor,any recommendations oe,;any,�oi6er commenU.T,; ,te
Use Arawtngs of facihtyto.better'ekplain s,tuat,'ons (use'addiittottal pages as necessary
�C1c�'�ias1-1 D1rl .St',•'�'e1 of► d SlzyS A,�
t`'iurl�hy►^'i���+�j i1Lls �►1'0r� r��rr7 �t�aLl �w�
or
7 e /'7 1.,., i� riven rd s .
K�, ef a coo � �-F I q )a1a y, c s ure rep -�~� - P f
Tk. �ot,��. War S i ne4C-ri 1jC AV— -1�C{r , 1 tl e P:es4 GV61c `Y Itpgs
'are �dN .•eA&4 -ror V%Acq kE�-�►1c idol Adlat•, S�_14e_^, sL,dulti 6c• hut[
o E ra-I i nhQ/ 6 F-e b # VA, 23) 20 OD . �4 ;s r Urr e- n � � W rF , 0 0 01 � —
ReviewerlInspector Name
Reviewer/Inspector Signature:
Date
Z
3/23/99

Facility Number: ai -�37� Date of Inspection 1
)fir .I:�;ues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
,% No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
[:]Yes
;Z No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
,� No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
[:]Yes
No
1tiona oIItrIIents an or raWlri 5 = k
is. work 4o es4a bl:At, ber P-Wda over ev14it4 �T a-� tie�O�. Sav►�C
OteeoS ray +,eeOf 4o �e J-rr9eOf -10 9e4 A 1k#er -foe� tdf
3/23/99

Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
MRoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection Z Z
Facility Number 3�
#Registered
Time of Inspec:tion 24 hr. (hh:mm)
©Certified 0 Applied for Permit Mermitted 113 Not O erational Date last Operated:
Farm Name:............. .Ir L :.........._. �C'A'(ff fj1���%'1... County:....... L..-:................................................
f2...
Owner Name: .. Phone No: .........:.. .....
Facility Contact:..�1t%L r%J.�� LGL........� .... itle:..,t/,� n.100.................................. Phone No:.....................
/-
Mailing Address: �rac ., .................. ..........�.. U ,�,...., ,� ' ............................... ........1 ........ ...
Onsite Representative:..,/,r'L.dflr........f z,4G.......�a7ll�tntegrator:................................... ...................
Certified Operator;..1/.!/....f/./11;>... £� 6...... .......... .�............. .......................... Operator Certification Number;..................
Location of Farm:
0
Latitude • 4 0'1 Longitude • ° 46
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
2.
Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If 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
El No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
[9 No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
E(No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
6o
7/25197

r �
Eacility.Number: — (0
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsMolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
KYes ❑ No
❑ Yes KINo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ......... �'. �...............................................................................................................................................................................................
10. Is seepage observed' from any of the structures? ❑ Yes [3VNo
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 WIv or, runoff entering waters of the State, notify DWQ)
15. Crop type ................................................. ................................... 1,�.:.1.r................. ............. .....................
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/]nspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onl
23. Does the f '4 o have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted w lianc�ofthe Certified AWMP?
25. Were any additional problems noted which cause noncompliance
0 No.vioilationsor. deficiencies:werentited•du ring this:viAt.•:Y.oik'.�ill recei�e'no•ftirtfier,:
:. • corre*)OdejnO i out :: .
Yes ❑ No
Yes ❑ No
❑ Yes ® No
❑ Yes 4M No
❑ Yes ZI No
❑ Yes ®, No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
Yes Objo,qpj
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
j?. /1 Z, G�c� �� 12r /���'L ��,r•. .�-cf r��t ,�s%l�s / ��v�.,�. �v�+--�%� f
0 /L/-4WG k � r
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector
Date:

IQ Routine 0 Complaint Q Follow-up of DW ins ection O Follow-up of DSWC review O Other
Facility Number
Farm Status: [9 Registered ❑ Applied for Permit
❑ Certified ❑ Permitted
Date of Inspection I r7- 19-
Time of Inspection I I - LQ_j 24 hr. (hh:mm)
Total Time (in fraction of hours
(ex:.1.25 for I hr 15 min)) Spent on Review
or Inspection (includes travel and orocessint*)
❑ Not Operational Date Last Operated:.................................._.......................................................................................... � ] ............
Farm Name:.. ! � .1�..... ....l.In��C1�......�P4Y!!�.................................. County:.. J�1� u � 1..1�.............................. ..1/.1.
Land Owner Name: ..............lt%.L.lj.&. ............................ Phone No:...... ,[Q:..r fi..-. %f%.. ............
FacilityConetact:........q..............�.......................................................... Title :............................ ....Q............... Phone No:..........................................................
Mailing Address:.....I..1.�Q........+.1' ...1. fap..... fkd.... ............... ................. ........ .L1m.........
..!�y1�a..�.�........ _. ..... ......... .........
.��.TS�.
Onsite Representative:...... .................. r^'`�. !.................. ...... integrator:.....''. ` * x ................................................. ..
CertifiedOperator:............................................................................................................... Operator Certification Number:..........................................
Location of Farm:
.. ........... rAIrS.......j......................4
..1 ^. ............ t.......5n1..`. ...5.. ................'...................................................................................................................................... �i
Latitude Longitude ©• ®' zj
-General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 9 No
2. Is any discharge observed from any part of the operation? ❑ Yes 9No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ) ❑ Yes R No
c. If discharge is observed, what is the estimated flow in gal/min? 1 A.
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) [--]Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes H No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes RNo
maintenance/improvement?
4/30/97 Continued on back

Facility Number:....[..... —..5.
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?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/Ur lielding onds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
Z
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?
❑ Yes I,No
X Yes ❑ No
❑ Yes 19 No
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type . a.�;d.. ......:7r..............................
..............................................
......
I.............................
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 the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP7
24. Does record keeping need improvement?
❑ Yes K No
❑ Yes 9No
A Yes ❑ No
❑ Yes K No
❑ Yes .®.No
❑ Yes R No
❑ Yes I.No
,Yes
❑ No
❑ Yes
19 No
❑ Yes
12 No '
❑ Yes
NJ No
❑ Yes ® No
❑ Yes KNo
IR Yes ❑ No
Comments'( refer to'question #)' Explain any. YES answers and/or any recommendations or any other comments
Use.'drawmgs of facility to better explain situations; (use additional pages as necessary} Y
, F.
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Q
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be.�.'V„ .
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-ra
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OL i-titer... S P —~ 2 r¢� a
Q.� b olyt .
Reviewer/Inspector NamepW
p,
Reviewer/Inspector Signature: Date:
cc: Division of Water Oualitv. Water Oualitv Section. Facilitv Assessment Unit 4110197

f
Site Requires Immediate Attention: ✓
' Facility No. "3.1— `3&
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: LI L ,_ 1 A(Jo, Q46w, 1�
Mailing Address:
County: 0 ..o 0 N
Integrator: W"XikPhone: �v-) 0
On Site Representative: `u� ft�rr; Phone:
Physical Address/Location: 19 y 9 in", L" 4411 Al
Type of Operation: Swine '� Poultry Cattle
Design Capacity: 1 r R L 1�,� Number of Animals on Site: 1�
DEM Certification Number: ACE DEM CertificatiNumber: ACNEW
Latitude: _° Longitude: �_° �S S 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 Actual Freeboard: "���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? 'iVor No Is the cover crop adequate? or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings or No
100 Feet from Wells? �s r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
-similar man-made devices? Yes or 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: n: n ) S•
. � , ...,.�:-�� ---�� DER. �� L, m,... Ar#A-�
•
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.