310545_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: A.Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit; K Routine 0 Complaint O Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ; Q County: eyI f� Region:
Farm Name: Ck' (� Fit� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: p
Onsite Representative: (J0%4�Q,n � Ul I LLO Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: f (7 3 ol'V
Certification Number:
Longitude:
W 3
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
on-Laye
Dai Calf
Feeder to Finish 12,oO
/DOU
Desigu Current
D , P,oul. Ga_ aci P,o ,
Layers
Non -Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other —TurkeyPoults
Other
Turkeys
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)
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 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 1 of 3 21412015 Continued

Fa ility Number: f2l -Tt�j Date of Inspection:__ I
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: R
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 9, No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ 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 V(No ❑ NA ❑ NE
maintenance or improvement? llll
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 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 [3 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
❑ YesNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
rE�No
❑ Yes No
❑ NA
❑ NE
Required Records &Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ONo
❑ NA
❑ NE
the appropriate box.
❑WUP El 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 l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes -21"No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesL;;Mo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

a ili Number: - Date of Inspection: -7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑NA ❑NE
❑NA ❑NE
❑ Yes 4No ❑ NA ❑ NE
❑ Yes ❑ No IeNA ❑ NE
❑ Yes I Z No
❑ Yes (dNo
❑ Yes fNo
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes pr"o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ONo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES,answers and/or any additional recommendations or ny.other'comments:
Use drawings of'facility to better explain situations (use additional pages-as.necessary).
Reviewer/Inspector Name: �!
Reviewer/Inspector Signature: ,i✓��
Page 3 of 3
Phone: _(�-10— r �y�
Date: 3
2/4/201 S

Type of Visit: Q Co lance inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: © Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ry
� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
'Z6
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oultr.
Ca _acit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
keys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: T
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes La"'No ❑ NA ❑ NE
❑ Yes F3"oN❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes Z/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm?I�o
threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�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
LZ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available? ❑Yes L=J N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes h 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 to ❑ 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 0Zo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. I� the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yesg�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 �T ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes l�l No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes to ❑ 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 O ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 2/No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNq
N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer,ta.equestion #):,Explain any.YES answers.and/or any additional recommendations or any other comments.
use,drawings.ofafacility to better�e'zplain. situations (use,additional pages;as necessary):: „
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone 910 X -1 J � 0
Date: g
2/4/2015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[teason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: OqQ6 Region:RD
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: , y l j G zV,1 —5, Vq I U`t
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:���
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Non -layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dr, P�o_uIt . Ca aci P,o .
La ers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
I
Boars
Pullets
Beef Brood Cow Ed
11-
Other
keys
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 ;;�rNo ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Zf No ❑ NA ❑ NE
❑ Yes �T`No ❑ NA ❑ NE
Page I of 3 21412011 Continued

pp_'�'
r`
FacW Number: I - . ^,,� Date of Inspection: f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes OKNo [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes Lallo ❑ 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 PI —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 P'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes PrNo
❑ 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 [2r7No
❑ NA
0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes EfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PT�4o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
2rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
WrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
)2rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Vf No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
VNo
❑ 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 CXNo
❑ 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 11 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VN
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

r-acility N umber: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gi `No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 12''No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels v
❑ 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 ZT� No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E2rNo
Otherlssues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
PTo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
TT
24. 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.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
VTNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
56No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
VT
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
7No
❑ NA ❑ NE
Comments (refer to question ft 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (itJ¢ jG1-
Date: T7-,"7- 14
21412014

i\_T
3
(Type of Visit: 0 Compliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: QfRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: t }, �1\ Owner Email:
Owner Name: �%� ��'�'Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Region: WAID
Onsite Representative: 140.,Jlt �W)-6y— Integrator:
Certified Operator: „ Certification Number: 1D
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
MEMMMEL"_es Current Design Current
Swine Capacity Pop. Wet Poultry C►apacity P.
Wean to Finish La er
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Nan -La er
Daia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Farrow to Finish
D , P,oult . C_a Aci P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 XNo ❑ NA ❑ NE
❑ Yes 2TNo ❑ NA ❑ NE
❑ Yes ❑J`No ❑ NA ❑ NE
❑ Yes
6 No
❑ NA
❑ NE
❑ Yes
Ef�I o
❑ NA
❑ NE
[:]Yes
[!fNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

e
LIFacility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [!(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2rNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _r
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 RTNo ❑ 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 ff No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 7rNo ❑ 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 Ef No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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
EjNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ZT No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E f No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VjrNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2fNo
❑ 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. [3 Yes [TNo
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�rNo
❑NA FINE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes f] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes V�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [6 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2TNo
❑ 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
iff 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
YNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile'drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[TNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNW?
❑ Yes
16Na
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L6No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C�rNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to.b-e-tter explain
�situations r(use additional pages as necessary).
eeAf
�irY1 a: coed
cm-�-%nwe okw Jam' J
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�j
v
Date:
21412011

Div'isian of Water Quality
)E~acillty 11 i1 m 1: r ( - '� Division of Soil and Water Conservatioa
O Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visi : -Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: ArrivalTimed /105 1 Departure Time: i/ y County: {,fj1/ Region:
Farm Name: l�Eu� V`��IVI Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �{/� L�iNI C-Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
ILayer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Cd
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to finish
Dt. l;oult .
I Layers
Design Current
Ca aci. P,o ,
I
I
Cow
Non -Dairy
I Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Turk e s
Turkey Poults
Other
jBeef Brood Cow
Other
OtherI
I
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)?
❑ Yes 1�No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any 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 21412011 Continued

Facility Number: j - SKIS Date of Inspection:
I,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: F
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
Q NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes I 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): ( dQ.IJ w 06#4 T COTWO% / `+� `C-C? �l
13. Soil Type(s):
g f301_0
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
E]WUP QChecklists [] Design Q Maps ❑ Lease Agreements
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
EZ�No
❑ NA
D NE
❑ Yes 15�'No ❑ NA ❑ NE
❑ Yes _1;3"'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
Q Waste Application Weeks Freeboard 0 Waste Analysis • Soil Analysis Lx1plaections
o Transfers
PP ❑ Y Y ❑ ❑
E] Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections ❑ Monthly and I" Rainfall
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
Q Weather Code
Sludea Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: jDate of Inspection:
X
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ANo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA �q NE
the appropriate boxes) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No XNA ❑ 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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes gNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CO]NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
tNo
❑ Yes
NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yeso
❑ 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).
jUF�� aot� sCkDCAc
w. A -
IL�Z-6pof-T '5TICL CALC5 ('QiLL-lMC 6ki /S bow/ %Qnwl L !} 7- �1C1�
( 10MT-j cv`/
6Et� �Mac.� � 1 � c,] c�6 �QDr�7�%
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

• 1Divi"sign of Water Qiality
Facility Number I - S� S OO Division oMISoil and Water Conservation
® Other Age, n�cy
type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q I I Arrival Time: ® Departure Time: ® County:
Farm Name: �',-7t-r---lam'' PAQ'f ) Owner Email:
Owner Name: [ �t_i (� c��FAm 1 Z�A 1j:7ACZMS C..(CPhone: 9SD-- 13by n i_ S
Mailing Address: Q'+ ` �QXJ;Z[PA/E] C4LAc-C Vd /VC DES/
Physical Address:
Facility Contact: Title:
Onsite Representative: GgUg 5N1 l T
Certified Operator:
Back-up Operator:
Phone:
Integrator:
�t1
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
1 � g0
Finish
rFeeder
Design C«urrent
Capacity Pop.
Wet 1'oultr,y
La er
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Feeder
Finish
QQ
Dr. P,oult ,
Layers
Non -Layers
Design
Ca aci.
Current
P,o ,
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke 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 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FaciliNumber: ] - Date of Ins ection: 10 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (14GOod
Spillway?:
Designed Freeboard (in): 1.
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 environme tal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
$. 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)
rs
9. Does any part of the waste management system other than the waste structures require Yes o DNA ❑ 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): CnaW w, 14
13. Soil Type(s):
1LE
14. Do the receiving crops differ- om those designated in the CAWMP?
A770X El�-O
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
[:]Yes 6No DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
QWUP []Checklists ❑ Design 0 Maps Q Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Wjt'ste Tr sfers Q Weather Code
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections 0 Monthly and V Rainfall/Inspections [] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes] No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes PNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ 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).
m
1-t
oQj3III I. 5
colt_Q_ t>zi FJA-7�11 �� '�� 1� �--o� �IC�—S71&LIVE0i SUC F'O(Z �1
PUL S�MPe-E S C AI-c F-olz MO -E c AXf aF &f
r tfc'flS
JtlD t� S caN FAQ S io
Cp a
(,'?PRTF 1 ��Q5 Fo rR- ARa r` P� P�xC w H. ��l Er.J %,3. 4. om u 6s
Reviewer/Inspector Name: HMA9
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4M11

5y 5
Type of Visit VCompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit �6 Rautine () Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: (��J iI�F� a /l • /N/1( �AZlA Owner Email:
Owner Name: Qr_(&FLC/-j %V _ OLA//VAI Phone: gig _ (0 Sg—'3YU3
Mailing Address: 191 1 n2QG!=1E V-6 I i 6AX I O -1UE /IVC DR to
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: f i CH � L � • U0 Al-LACi=
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
C%10 I'1
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ 5 [=41 Longitude: 0 ° = ` =
DesignCumrent
Design
C•iggyt Design Current
Swine Capacity Populatiton WePoultry
Capacity
Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer I
I ❑ Daia Cow
❑ Wean to Feeder ILI Non -Layer
❑ Dairy Calf
gl Feeder to Finish
❑ Dairy Heifer
El Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Gilts ❑Non -Layers
❑ Boars ❑ Pullets
❑ Turke s
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Other ❑ Turkey Poults
❑ Other IF1 Other
­7dNumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 'No ❑ NA LINE
[]Yes ,�o ❑ NA ❑ NE
12128104 Continued

Faci ity Number: —.5y5j> Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �/v
Spillway?:
Designed Freeboard (in): R.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,, ``
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes )kNo ❑ 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 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes N(No [:1 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 El NE
maintenance or improvement?
WasteApplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
I�(J
No ❑ NA
El NE
maintenance/improvement?
✓✓✓ "`
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
kNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ❑_Application Outside of Area
12. Crop type(s) craw , �iHe,4 ; S e"7 �� CL Cc i ftj?' !'i. *- T0(3'ACC cb
13. Soil type(s) AtxTGLmp1L.LF'
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
tNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
\� No [I NA
r
El NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
WNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Mo ❑ NA
❑ NE
.Com mentg (refer -to question^,#): 'Explai&any YES answers" and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages, as necessary)..A
AL
N� P t.A I pow r cop- o
Reviewer/Inspector Name ;:. MI AA1O G A r - a: Phone: '1 G LP
Reviewer/Inspector Signature: awry Date: V
Page 2 of 3 12128104 Continued

Facility Number:' ( — y_q Date of Inspection J(0457JCj
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [] XNo El NA El NE
W
the appropriate box. UP El � Design � Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes)4 No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ /ste Transfers ❑/nnual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections 3 Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JXNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
*o
El NA
.❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the 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
ONo
❑ 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
0No
❑ 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
N[No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
oNo
❑ NA
❑ NE
Additional Comments and/or Drawings: `=
llrlasloq 1- y
1� alo9 �.S
oLj CW AN 6'E o F- (f> C-
�vr
](A 9O l l
Page 3 of 3 12128104

Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit VRoutine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 2A Arrival Time: CGi Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 4Ir. Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email'.:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = c =.
= « Longitude: = ° =' =
Design
Swine Capacity
Current Design
Population Wet P,ouftry Capacity
C►urrent
Population
Design Current
Cattle . Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ DairyCalf
❑ Feeder to Finish
Dry Poultry
❑ La ers
❑ No ets ers
❑Pull
❑ Turke s
03 urkey Poults
❑ Other
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Beef Feeder
❑Beef Brood Co
❑ Boars
Dumber of Structures:
©then
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes eNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ti o
ElNA
[INE -
❑ Yes
o
❑ NA
❑ NE
Page I of 3 12128104 Continued

Eacility 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?
El NA El NE
❑NA El NE
Struct e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes VNO
❑ Yes
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No El NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZfNo ❑ 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
,TNo
❑ 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
�,�
L�J No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ZfNo
❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
,!J No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
PNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
FNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Fzl No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ZNo
❑ NA ❑ NE
z&^^
Comments any YES"answers and/or any recommendations o'r any other comments.
IUse drawmgsi©ffactlity to beftergezplarn sifuahons. {useiaddttionial.pages as.necessary).
i
7
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 09
Page 2 of 3 12128104 Continued

U
`Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 qNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[;f No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
l
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
J
/ /Vo /
12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit, outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Regioniile
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certifica on Number:
Back-up Certification Number:
Latitude: [= c = ❑ « Longitude: = ° = d
Swine
Design C►arrant
Capacity Population
Wet Poultry
Design Current Design Current
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
on -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Pullets
❑ Turke s
❑Turke Poults
❑ Other
❑ Beef Brood Co
Number of Structures
❑ 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?
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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
W No
❑ NA
❑ NE
❑ Yes /No ❑ NA ❑ NE
12128104 Continued

' FacilityNumber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ETNo
❑ 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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes JZNo
[]NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes PNo
❑ 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 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VfNo ❑ 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 VfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,2�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes 9No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ONo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes El,�qo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ho'-4ZZZ2 - aid Of
Phone: y
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;;MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
D2'1. oes record keeping need improvement? If yes, ck the appropriate b below, [I[IEles No NA NE
❑ Waste Application ❑ ❑ Weekly Freeboard aste Analysis S it Analysis El Waste Transfers El Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 20 Minute Inspectio ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ieI discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
le[�. n_-_111
,2 _7
2,1
❑ Yes JoNo
❑ Yes ❑ No
❑ Yes PINo
JZYes ❑ No
❑ Yes VfNo
❑ NA ❑ NE
VNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑J110
❑ NA
❑ NE
❑ Yes
El NA
El NE
El Yes
.9No
,,//�No
❑ NA
❑ NE
fIS
eroL
- �a �o�� � �e�
Nm�f
350 -ahoy
A lo Sk J 1/, e 7
/IPP �o cc�-, leole as soor�
Page 3 of 3 12128104

(Type of Visit .2tpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other [I Denied Access
Date of Visit: Arrival 'Time: -7, 501 Departure Time: County: Region:
Farm Name: toutna Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ff/�(f!� C _ _ Integrator: 0' 014�
1 AV
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = 4 = Longitude: = ° =
Design
Current Design Current
Design
CurrCent
Swine Capacity
..
Population . , V�'et Poultry. Ca aci Pko ulatiom .
ul p, t p
Cattle ° }x
Ca aci `
P ty
Po ulahan
P
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ an to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
?
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
-•:
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:Ej
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ,ETNo
❑ 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 ZTNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ETNo
❑ NA,
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes �No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facigty Number:.' 11Date of Inspection Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes .�ffNo
❑ 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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes .Q No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 2 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,,ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes El ❑ NA ❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes J2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% 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
Z'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
eETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
-ET No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ 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):
r 8AC C1C � �uf IrrYl pi pc�1•-� i.(.S 1AL
Sals, S
Yv�a_
Reviewer/Inspector Name j H f �GZJ� s�r� Phone:
Reviewer/Inspector Signature: Date: IFZ 6 Q
Page 2 of 121IRM4 C ontinrivd

• Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other ,�(
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I[J No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ONA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
B NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
WNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
10 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes .0No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
, R'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑"No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
j2No
❑ 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
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�� CIS
� cn cl�� ���-d w� � �
ff/t�j„
1 fJ �c�rcQsA`� �` o i`d�%�i�°
Page 3 of 3 12128104

`Y ^F i �,`y,,. m • Y. W: �i A1�r JC^'�
s Q I?ivrsion of Sod and Water Conservation x"
1
4
iD.Other Agency
-: - - .�a,: T
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ,�Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
F7
Number Date of visit: FWN2ot
Time: 9,K3 (Operational Q Below Threshold
�rmitte�l,eertified © Conditioon�aR Certified 0 Re�red Date Last Ope ted or A ve Threshold: ...._.WW._ ..
Farm Name:...,.../ - - �- County:LY1.._ . _..._.
OwnerName• ............................................ ................................................................................ Phone No:..... ................................................... .....................
Mailing Address:
Facility Contact: ............... Title:.. .•-_-------------- Phone No:
Onsite Representative:.... ft j•Jj! � .AiNi s........ �., Integrator: {��'
Certified Operator: ....................... . ...................... Operator Certification Number.
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude
Longitude �• �� ���
r
Design Current Design
Cori eat - .: Dmgn Current
Swine Ca' ctPo matron Poultry' '_ " - g
-=,_
Po "rlafloi% r Cattle Ca Waco W °Po elation "
..
Wean to Feeder
' ❑ Layer
-^ [] Dairy
is Feeder to Finish
❑ Non -Layer
p= ❑ Non -Dairy -
Farrow to Wean
Farrow to Feeder
❑ Other,
Farrow to Finish
Total Desilgn Caparaty
-= ❑ Gilts
Boars
Y T©W SSLW
,Ndi"e ofF-Lagaans
-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/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 kQ-Ko
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KJ 1Vo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes eNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ..../...................................................................................................................................................................................................
Freeboard (inches):
2112103 Continued

Facility Number: S Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance./improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessh
12. Crop type
13. Do the receii
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?
I6. Is there a lack of adequate waste application equipment?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 0.90
❑ Yes P-<o
❑ Yes ,0 No
❑ Yes E�No
❑ Yes I a<o
❑ Yes gNo
❑ Yes J;No
❑ Yes �No
❑ Yes .ErNo
❑ Yes },�_,1/ o
❑ Yes ,lam No
Yes ❑ No
❑ Yes .2No
❑ Yes j'No
❑ Yes ONo
❑ Yes )2-Nb
❑ Yes ONo
(re%rataquestion.#)�Exptam sny YF�fi;answers andfoir any:at�oas ar'nny atner comatnts.s
"CO
Use drawing oaf fsctlsfy t"beiter1an s?tuatioris: arse addttio al es asEnry). Field&i Fu►al t s yw
Copy ❑
I t� 1pj (//i�� W �O`L 0 '0�11 &V_1;;faC4_
.r
4
Reviewer/lnspector Name ;7-.� _ r
..r .W
ReviewerAnspector Signature: Date: O
12112103 'r Continued

Facility Number: J Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? P-Ires ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, wraps, etc.) ❑ Yes ;]Ao
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,8lq*o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 01ro
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes J2 40
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑ 21L
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes )'No
28. Does facility require a follow-up visit by same agency?
❑ Yes ;3"No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes )2NO
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes ,21o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditronai Comments ancllorDrawrngs - rt
pkkS� Cer+1Fca.k o-IC Cove. e, c yl
1?e c_alyls ane, j-7,ea7' V- Qom/
y
Call �'�' CGS C��rto� ,dam �Ou�oJ
y/Cl) -3gS C3po0
12112103

1.ti
Type of Visit 1,5-Complianoe Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit (URoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: I 125ATime: I!.�f�'_J
Facility Number
Not Operational 0 Below Threshold
® Permitted 03 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: _ lCf ) PCtk Quo /1__ _ _ County: _ b I
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: _..AaeIDL
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �• 0 " Longitude 0' r
Discharges & Stream Facts
1. is any discharge observed from any part of the operation?
❑ Yes JdNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes JDNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes j No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes U-No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

4 t-
Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not 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)
T Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
❑ Yes ZNo
❑ Yes 42No
❑ Yes ErNo
❑ Yes ZI No
[]Yes 4�!rNo -
10. Are there any buffers that need maintenance/improvement?
❑ Yes
,0'No
11. Is there evidence/off over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
�o
12. Crop type [ _DER W,4el7oe 7y(i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
a To
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
,BNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
.2"No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
LD14o
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
ZrNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
,ryes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
BNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
zaJo
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes .'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ZNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ,{No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes ICJ No
0 No violations or deficiencies were noted during this visit.. You will receive no further correspondence about this visit.
Gotrlineiits,.(refer t6;quesdon #):- E:plain any YES°answers andior;any,recommendsttons:or aay.other"cummei►ts.
_
iise.drawiitgs of facility to Better exptatn sit mflons.(use additional pages as necessary):_'- ❑ Field Cory ❑ Final Notes
%/�✓7,tjl 41J�'!,!'Ck�ie�!�
�h Ao✓• 20D/ {[Are- di'TS /We- 4,GD�y
MI'AIIOI -/0-- `,14 V ylC 4
/mot-ullAf, �.tr�7� /'� %rOd 71d-,,e)A (,a MI lei.
1 sf,41 lfeuv�r
Lo.1s
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: %
05103101 Continued

.cam
Facility Number. 3 — bate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 12.<o
liquid level of lagoon or storage pond with no agitation? ,z
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �!tio
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
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 o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blad e(s), inoperable shutters, etc.) ❑ Yes LJ-1"o—
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 12<o
Additional Comments and/or Draw•ings:
O5103101

-TDIvIsion of Water,Qualaity
C"
Q ])Nismon of Sod ana_Water.Conservatlon.
_..' 'ch 1, 6tlker.AgenCy
_,yek' ... -J
.s ,i
Type of Visit IgCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit WRoutine O Complaint O Follow up O Emergency Notification ()Other ❑ Denied Access
Date of 'Visit:
Facility Number
Permitted,0Certified E3 Conditionally Certified © Registered
Farm Name: je�AJ'.........
................-.'....ems.. vI'I....ar'ti,.......................
Owner Name: X.e C uA
....................... �.... Q. �.�!.!.....?............................................
10 I Time: I ( Z. - Printed am: 7/2112000
Not Operational O Below Threshold
Date Last Operated or Above Threshold: .........................
County: , �U��.!................................... .
Phone No:
Facility Contact: ..............................................................................Title:.............................. Phone No
MailingAddress:....................................................... ...........................................................................................................................
Onsite resentative:. Td)^1. Re tt G� M ve Fu r t�S
p �r�...................................................-_.............. Integrator:................ f......... `1............_..
Certified Operator: ................................................... ................................................. Operator Certification Number:
...................
Location of Farm:
I�
09 swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° ��� Longitude �• �° C�s<
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish / ZdQ ) j ❑ Non -Layer I I❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JEI Subsurface Drains Present ❑ Lagnnn Area ICJ Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If dischar�ie is observed. what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes PTNo
❑ Yes ;KNo
❑ Yes Ej No
07/,q
❑ Yes J9 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JZ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 2�No
Waste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure
Iden ti f is r: .............. I............... .......... ..........
Freeboard (inches): 51
5/00
❑ Spillway ❑ Yes X No
Structure 4 Structure 5 Structure 6
Continued an back

Fa'olility Nnrnber: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,ff 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 9No
(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
ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
No
elevation markings?
❑
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
01 No
12. Crop type Ce rr? I W he-4 4Sa �+eq�t S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
JA No
b) Does the facility need a wettable acre determination?
❑ Yes
JR No
c) This facility is pended for a wettable acre determination?
❑ Yes
P9 No
15. Does the receiving crop need improvement?
❑ Yes
)j No
16. Is there a lack of adequate waste application equipment?
❑ Yes
�4 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
;9 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
No
(ie/ WUP, checklists, design, maps, etc.)
U
J9
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
F No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JA No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
O No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
freeboard
❑ Yes
No
(ie/ discharge, problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
24- Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
M-yioiatigris:oi- deficiencies -mere noted. du -ring this'visit; • Y00 0114. 0..0..
. . l.ad further
corres ondence abauf this visit. - . - . - .
Comments (refer to question #): Explain any YES answers and/or anyrecomme�ry}ns or any atlier cona5nents�J
Use drawings of facility to better explain situations (use additional pages as nec •1 retords are welt ke&
�G, t
%3, Nee �o e93 svre Oka � oile r"ore Yd�"a�t-' v1[ zarte bGs;clLS d��+►�.s
ce'o�i'K7
Reviewer/Inspector Name lnlg . Z►' _";
Reviewer/Inspector Signature: Date: 5100

11
FaciEWNumber: 3 —5 Date of T.nspection 2 3 O 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;/or Mow ❑ 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 ktJ 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 fNo
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 j1O No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a peimanendtemporary cover? ❑ Yes 0 No
[Additional:C-omments and/or. ravvings:
AL1
5/00

Routine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection © 24 hr. (hh:mm)
© Permitted P(Certified 13 Conditionally Certified 0 Registered 113 Not O erational Date Last Operated:
` 1
FarmName: .... 4:�1+.^...1�._......:�:�............................................................. County:........... .........../ �..�:1.r..1............................ ........
Owner Name. Phone No: 9 (� ! � 3—L...................................
03
...............
FacilityContact: .....................................................----................--...Title:................................................................ Phone No:
MailingAddress:........................................................._.............................................................................. ..........................
Onsite Representative:.. .'`' ............................. I........................ Integrator: ......... 1.F1............................................
Certified Operator: ... ....... ...................... ............................. I ........................... I ... Operator Certification Number:..........................................
Location of Farm:
Latitude • ' Lf Longitude ' ' "
Discharges & Stream I,m�acts
1. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon [ISpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ................. ()......,
❑ Yes ❑ No
❑ Yes �fNo
❑ Yes PNo
❑ Yes 0 No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes "'gNo
Continued on back

�.: Facility Number: "N -- Date of Inspection
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
�SfNo
9. Do any stuctures IAck adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
b�No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
VNo
11, Is there evidence f over application? []Excessive Ponding ❑ PAN
❑ Yes
�(No
11d
12. Crop type L�G
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
IR 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
14 No
16. Is there a lack of adequate waste application equipment?
❑ Yes
WNo
Reuuired Records & Documents;
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9No
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
WNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
WNo
21.
Did the facility fail to have a actively certified operator in charge?
Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
1Z No
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JSrNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
t(No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
b No
Rio vio�aiicjns:or• docie.neies •were inQted• diW id this:visit: • Y;oti :wiil•reeeiye Rio further _
corres'otidence. about. this visit ...... . ... ........ ... .
to question #) Explaiwatiy YES answers and/or any recommendations or any
acility. to better explain situations (use additional pages':as necessary)
comments.:
251) o \ 4RA-� Zr1 C �?+ed� h
Reviewer/Ins.31
pector Name' r a- ` '
Reviewer/Inspector Signature: _ Date: r7 _r] 00
AL

Facility Number: — 5 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
KNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
9 No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
ONO
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
[)(No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
eNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
bdNo
Additional, Comments an or rawings:
C�) �y
'5A
v4e-
J'�
lqo
ot11 5
QAiCQ'-3x�
zi

r
s "
[3 Division of Soihand
1 Division of Soil and s
Division of Water Qi
e. .. [3 Other Agency Opei
Routine O Complaint O Follow-up of DWI
Conservation =Cot
I< _Compliance "pe,
nReview;=
dorE;Review
HanceInspeckon
)n =
Follow-up of DSWC review 0 Other
Facility Number
Date of inspection
(� ( r( 11 1J
Time of Inspection
I
2-30
24 hr. (hh:mm)
I
Permitted Of Certified
Q Conditionally Certified
13 Registered
Date Last Operated:
113 Not O erational
Farm Name: 4.....................t'`!......................_.........._..........__........................
w
Q
y
Count.........---......
y= .............
...... I�
OwnerName :...................................................
..... ........................................
........... . Phone No:................................
�. k1,
1U'.--�
Facility Contact: ........I ................
C .....
�.r.._..............................
��.......
Title:..........G" i 5.... ................
Phone No:
. 73406
Q.....................
MailingAddress: ................................... ..........................%...`.._.....�..............�................................
Onsite Representative:.~"_ ( "v t �`��
.........................................................................
Certified Operator: ...................................................
................................................................................... ... I ... I.................
Integrator:.... ... ......
.............
I ....................................................
Operator Certification Number: .........................................
ocatiqp of Farm.
HC
Latitude Longitude =• 1 =[L
Design Current Design. .urgent Design Current
F_`_..
Swine.. ,: Capacity Population Poiiltry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
QO
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
©Spray Field Area
❑ Subsurface Drains Present ❑ Lagoon Area
Il�umber>of:Lagoons
Holding -Ponds / Solid Traps
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P�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 Statc? (If yes, notify DWQ)
❑ Yes
❑ No
e., If discharge is observed, what is the estimated flow in gal/inin?
d. Dees 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
IgNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
[K No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(inches): ........3....!......................................................................................_ ................................ ...................................
...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
( No
seepage, etc.)
3/23/99
Continued on
back

Facility Number: 3l —S Date o1' Inspection
F
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum -liquid level
elevation markings?
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_ 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?
.Rd vibZti ris:or deficiencies were n¢ted d0fing this:visiC .:Y:oit will -receive fio further
corresondence: abaci this :visit.
❑ Yes �(No
Kx Yes ❑ No
❑ Yes C`No
❑ Yes X No
❑ Yes M No
❑ Yes IN No
❑ Yes
9 No
❑ Yes
XNo
❑ Yes
V' No
tYes
XNcQk
❑ Yes
k No
❑ Yes W No
❑ Yes 91 No
{Yes ❑ No
9 Yes ❑ No
❑ Yes 0 No
❑ Yes UrNo
❑ Yes 0 No
❑ Yes [N'No
❑ Yes E�No
❑ Yes M No
Comments (refer'to question #) =Ex" plain"any YES answers'and/or any recommendations or. any otli<er comments -
Use drawings of facilityto..better ex W lain situations. use additional a es as necessa
_ P f F g . �3`)
��1 �-l) ���1�`T1C1�•, �/ L C�� C��—`[L�i�e �1G-. 1r�Q_cks `� � CGI-►'2�.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
t • - .r � rr r ---t.f t 1 !'CLad l �,slz�e � - � • •• 3
Date:
3/23/99

Facility Number:3 — !!� Date of Inspection
ij
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
gNo
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 No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
JWWo
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
XNo
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
Q3/No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
XNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
PK
❑ No
NddifionAl C omments"an or
Mo CA)
�.cCr—
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspection g(g
Facility Number
Time of Inspection � 24 hr. (hh:mm)
19 Registered 10 Certified 13 Applied for Permit 13 Permitted JE3 Not Operational Date Last Operated:
FarmName: ..............?��....(1.1.nb.....1:......4fn.....`p..6ih .................................... County: ......... ba................................... .......................
OwnerName: ............................�bCiit".........QAjIAJ,......... cats.............................. Phone No: .... \......................................
Facility Contact: 7. 1( s...... D .*. ..... Title: ........................ ....................................... Phone No: , C919 T.6$� 3�a1�15........
MailingAddress: ......... I.01.)...... .po.1e.y..... U ..................................................................Nlf...... ....................................... Z4.4.6S......
OnsiteRepresentative:...._........_!.!! MOr l...._m5e_f ............................................. Integrator:.......... .......................................................
Certified Operator:............................................................................................................... Operator Certification Number :.........................................
Location of Farm:
Latitude =0=' =" Longitude =• =' ="
Design, Current m Design ' " Current' Design Current
5wme -Capacity PapulaGon Poultry "Capacity. Population -`Cattle Capacity Population;
�y ❑ Wean to Feeder_ y ❑ Layer I Dairy
Feeder to Finish I0Non-Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other -.-.. 4
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars " ' Total SSLW
m,
M Ni mber-of Lagoons? Holding Ponds'' ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
`V a
e , ❑ No Liquid Waste Management System
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
E5 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
M No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
P No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑Yes
No
3.
Is there evidence of past discharge from Any part of the operation? -
❑ Yes
[0 No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
tf
rLA No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[� No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
14 No
7/25/97

V
Fadlity Number: 31 _ S
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?
Structure t Structure 2 Structure 3
Identifier:
Freeboard (ft): ..............a5..!`�.... .......
14. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes [d No
❑ Yes A9 No
Structure 5 Structure 6
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...................... C[K.Irn........... W�WN............:�O_llotcu.& ................ .............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[] No.vinlations or. deficiencies.werenotedduring this .'Asit.-:You:w'ill receive, no,ftirttier-:
ctirresp�ridehce aboi:� this:visit: :: : :
❑ Yes 2 No
❑ Yes ® No
Yes ❑ No
❑ Yes ,91 No
❑ Yes P No
❑ Yes P No
❑ Yes §3 No
CgYes ❑ No
❑ Yes In No
❑ Yes No
❑ Yes No
{� Yes ❑ No
❑ Yes I? No
❑ Yes W No
❑ Yes V9 No
1Z., 1-&5c*h M. 6115 'S kw� be r►�awed .
1,2..'q_ i tT`%A�prr ftC"% Sjvud a at� G- "'? mOL,Lj 76 ocoq ,
IL-1 CarOt�l br. Ex+.. �slrr�i ��, 29gC'� Alta c s �� 4-
1 � 1 ,,� � 'rot' p
7/25/97

. � ❑ DSWC An�rna1 Feedlot Operat 6i ke k'21
r
s
n ®DWQ An1ma1 Feedlot Operatlon,Slte�Inspectlon � ��
>> xz
a _ w%`
140 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection
3 l 5�#�
Time of Inspection t p ; 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status* W Registered [IApplied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated: .... . ..... ............ ...._....... _.... _..... _ - -_.... _....-......._...
Farm Name:_...._........_....... County:.. �kP.�.4.�........ _.............. .... -..... -.
Land Owner Name:..4Rht.r ........... Phone No: aa&.... .._..... _ ..
Facility Conctact:... .._.... _...... ,.... _ .... _...._.--_---• Title; _.... Phone No:
4*0
MailingAddress:._.��-�t3.Ji:.�1{_.(........_. ........ ........ ........... _....-._....-.........
._..
Onsite Representative: - I.c ... ? tt p�. !: t Iistegrator: - . L f
Certified Operator: ....TCZ-
........ - .............. ...........a -.. ...... ........ _..... Operator Certification Number:
b ...
Location of Farm:
L t.5......1rh_V_V . In I.:a..c .k �
...................... _............. .... .......... .............. .............. ...._........
. .... _ .
Latitude ©• �� 0� Longitude ©• .7Z ° ®«
Type of Operation and Design Capacity
Swine Design .� :CapacityPo ulatiiin o1'ou1Y �uretC � �urent
xqw.'W
Cat�on a aci Po tior aact Po ul
❑ Wean to Feeder I❑ Layer ❑ Dairy
® Feeder to Finish; ❑ Non -La er El
` � " ❑ Non-Dai
Farrow to Wean4'
M d
Farrow to Feeder Total Destgn'Capaettj� �* Ke �
-, z
Farrow to Finish . I �SSAF
..� .,M."...v,,.0
�Lw�
❑ other ����'
� � T
Number oaf Lagoons 1 Holds©g Ponds 9 Subsurface Drains Present
❑ Lagoon Area Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes k[No
2. Is any discharge observed from any part of the operation? ❑ Yes 91 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 R No
c. If discharge is observed, what is the estimated flow in gal/min?.
d. Does discharge b}Tass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes $j No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 1@ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
4/30/97 maintenance/improvement? Continued on back

Facility I umber:31.7--.5-4- ss
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 0 No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
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)
❑ Yes ® No
19 Yes ❑ No
❑ Yes ® No
Structure 5 Structure 6
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type a5�.x �s^3...._..za7...._ .—......C��rar�... _...._ ......_........_.......................
16. Do the receiving crops differ with those designated in the Animal Waste Management PIan (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?
For Certified Facilities Qnly
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ® No
❑ Yes jR[ No
Yes ❑ No
❑ Yes 14 No
❑ Yes 9 No
❑ Yes JK No
❑ Yes M No
❑ Yes [9 No
❑ Yes ® No
❑ Yes 9 No
❑ Yes R No
❑ Yes ® No
❑ Yes ® No
0 Yes ❑ No
Comments (refer toyquestton #} ' Eacplain any YES'answers'and/or"any recommendations or any other comments.
Use dravhngs,of facility to better explain situations. (use additional pages'as necessary} r
. ,mot .
S• S Q v j� ��+i �i v+.t n �1 w. � As)Q
J
; to
$- L� e & L u o s �. a e 0. 4-p,r ►�.Q�.�.s L v 0 W% s u' I it, It
2-q • (T C t a w� c` P �'�-s S In. q W.S T e wV ••••• 4�+5 . !� o� �e S u r C
k'k. 4�S tr. C, Q- t ' 3 C-O V" "Q_e O-QS t
r e- C-o .. z} S, s e C u r .r e�vL f 5 0+ S V µ^ 11? V' e v 1 I
i z G• t l , -, e.r-n S c d ,n c a t s%" C v F-e- r L a-+1 u d W OL1 I u-�^-a `r it, v e-qale-
`J
�A^
Reviewer/inspector Name -.
-A `-{'�'•� 1�,t ..
, "' •'ire, "' X.:.#sa-dam-.. x.,, �.:w
Reviewer/Inspector Signature: Date: 1
cc: Division of Water Quality, Water Quality Section, Facility Assessmen nit 4/30/97

Site Requires Immediate Attenti n:
Facility No. ,
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7/ , 1995
Timern:
Farm Name/Owner: ,,
Mailing Address: rV I.6, -
County: " 1N
Integrator: /%L _ Phone: U �'S'`t it r
On Site Representative: *i'yi f Phone:
Physical Address/Location: -.X 1 vL> rS-/
Type of Operation: Swine -1 Poultry Cattle
Design Capacity: 1 / I G -1-49411,1 Number of Animals on Site: // 1� G -
DEM Certification Number: ACE DEM CertificVn Number: ACNEW
Latitude: 3,i 0 Z�' 13 " Longitude: -2 1_° 5-D' 3 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) �9or No Actual Freeboard: _!� -Ft. a Inches
• Was any seepage observed from the lagoon(s)? Yes or Q Was any erosion observed? Yes, or No
Is adequate land available for spray? (e or No Is the cover crop adequate? "?e or No
Crop(s) being utilized: 6b,;r-r&1 hP��., •� d _ __
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? lQor No
100 Feet from Wells? er 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 & 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: d !n� -MEr ^J Ay)n'ln-W
--
Inspector Name
Si afore
cc: Facility Assessment Unit . . Use Attachments if Needed.