310562_INSPECTIONS_20171231

1 19
NUH I H UAHULINA
Department of Environmental Qua!

S 62
Type of Visit: t) C MOiance Inspection U Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit_: _0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: jQ County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: j Title: Phone:
Onsite Representative: �� - (� re-4— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: II `'( 5-4
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
Dairy Cow
Design Gnrrent
Capacity Pop.
an to Feeder
L
JNon-Layer I
Dairy Calf
eeder to Finish 4O D
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Gnrrent
D . P,ouI Ca aci P,o .
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherT
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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 ❑ NA ❑ NE
❑ Yes2Nwo ❑ NA ❑ NE
Page l of 3 21412015 Continued

Facility Number: - S Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
U
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
16To ❑ 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 th , notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes - No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
U40 Ij NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZfNo ❑ NA
[] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No'❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
CO] Yes
NA
�No
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Oth
21. Does record keeping need improvement? if yes, check the appropriate box below. Yes ❑ No ❑ NA [:]WE
❑ 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_ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Nmnber: - Date of Inspection: D
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EjrNo ❑ 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 o rNA
NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [::]Yes ❑ No ❑ 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
ONo ❑ 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
6 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
Ej No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No A ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
C©imineutsT(refer � to gnestipn #):,Expla_in any YES=answers;and/or, any addifidnalrecoinmendatinns or -any other comments: ''. .
Ilse:drawings fac�ty Si[Witions°(use + i " 1; '�
of to better:explain additionat_pages as;necemary):.
Zl - S �pPy off / 01 c /V h
[v►"t
�+� g �,-t--, c b f y D� -l� ��.,P . �s, j,e lj
.
'K S 1"C e— ("r— Li C/' Ste— h 4
Reviewer/inspector Name:
�I( s) n ✓
v
✓t C (too X1 V-4�Dh1A oq Alec Phone: \ ; 7 9 6 —V,94
Reviewer/inspector Signature:
Page 3 of 3
Date: 7 f 4tr %
21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
d
Farm Name: �Pl;vl, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ' la �f M AUM,0 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: "--
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Pouitry Capacity Pop.
I ILayer I
C*attle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I INon-Layer
I El
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . UR-1tr,. Ca aci_ P,a
ILayers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkey Poults
Turke sLl
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
[�'No
❑ NA
❑ NE
[:]Yes
[2fNo
[DNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [?rNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [TNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes d No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number:` ' Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
in 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: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
Zf 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
Ej No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Wj No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Z[ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
.0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility 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 21412014 Continued

Facili Number: - Date of Inspection:
24 `Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,❑ No ❑ NA ❑ NE
25, s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No [] NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes .2] No ❑ NA ❑ NE
❑ Yes '0 No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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).
61111q G .
(.Ase, vdoL 4P_ ScLyy y led
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"y WC,' dare (e CWUed tr
}ll?v�n . Rot..��andsD-acden ar•50V 1
C) 6a rm. Co
��[f��3 • Farms �- �e o 5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: W 7Q�! Y J
Date: �7
21412014

(Type of Visit 42r ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O Routine �omplaint Q Fallow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: J Title:
Onsite Representative: _4zf a
Certified Operator:
Back-up Operator:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = = I[ Longitude: = o 0 S ❑ "
Design Current
Swine . Capacity Population `Vet Poultry
❑ Wcan to Finish ❑ La er
Design Current Design Current
Capacity Population Cattle C►apaeity Population
❑ DairyCow
❑ can to Feeder
❑Non -La er
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry poultry
❑ Layers
❑ N ers
❑ Pullets
❑ D Cow
❑ Non -Dairy
El Beef Stocker
❑Beef Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Beef Brood Co
Other
❑ Turkeys
❑ Turkey Points
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ N1
❑ NA
❑ NI
❑ Yes
❑ No
❑ Yes
,�fNo
❑ NA
'❑ NE
❑ Yes P To ❑ NA ❑ NE
12128104 Continued

L
F"acilIty umber: — Date of Inspection
Wastftollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;a/No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ 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
J'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
FetNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
/[-No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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
)2 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
,TNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E!rNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,3'-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9�o
❑ NA
❑ NE
m. u
Comments (refer to question 0 ,,Explain any YES answers and/or any."reco'mmendations or -any other comments
�� tom"' x
,Use drawings�of facility -to better explain situations. (use'addttional pages as necessary.) � ; 4
X/
12
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date: ` 1�
12 R/04 Continued

Type of Visit ,QFCornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit, outine 0 Complaint 0 Follow up 0 Referral 0 Emergency Xother ❑ Denied Access
Date of Visit: I XIAA /CMrrival Time:
Farm Name: _
Time: —yam County:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r01017 Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certitica on Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: 0 c [� [ 0 « Longitude: = ° = , =
Design C*urrent
Design C►urrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Turkeys
Qther
❑ Other
❑ Turkey Pouets
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PfNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facili. _Number: ' Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes P] No
❑ Yes ❑ No
Structure 5
El NA El NE
El NA El NE
Structure 6
❑ Yes C}'No ❑ NA ❑ NE
[:]Yes oNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [],No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PTo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes J2'<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
t t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'Ul�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes .12r No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P Ko
❑ NA
❑ NE
Comments (refer to question ft -Explain any YES answers and/oi anv recommendations or aniy other comments ":
Use drawings of facility to better explain situations: (use; additional pages as necessary) �� y. m
,,
�dS /I Call /bm Gil/IQ �� Aa/A 4G/rlC-G��,s'
dr
IdcrrlC�r�
e � i'v e-1a r GL�.S 11 f2sitL.G , 2i���f 4f i G fG/Yr �k 7�
W,16111dl % r
Reviewer/Inspector Name �ls�t W _]Phone: !91
Reviewer[Inspector Signature: Date: o
12128104 - Continued

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: lg"= Departure Time: County: - Region: L4
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: // / Title:
Onsite Representative: �l L7 C,Aa'^-,-7
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator: 271,6
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = i = is Longitude: = ° = I 0
11
Design Current111
Design Current
Design Current
Swine
Capacity Population
Wet Poultry
Capacity
Population
Cattle
Capacity Population
El Wean to Finish
❑ Layer
❑Dai Cow
El Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
❑ Feeder to finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
ElBeef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
0"Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
ONo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Oyes
❑ 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)
0Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
12"No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ YesANo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

FaeitityNumber: S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �3 o ❑ 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): 23
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Ale r/PUeI--1 q
/s� . � �c�l-� �/ � Svc aecl err •l-tl ��s f� c'l�c� nG l� lF'ci�.�- ��''le
Reviewer/Inspector Name j Phone:
Reviewer/Inspector Signature: Date: o
Pnno I . r 7 72/2R/10 (-antiavod

V
I
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit'J2,koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % 6 Arrival Time: a' G Departure Time: County: IL"Region:
Farm Name: S'O�.t� ��� Owner Email:
v -
Owner Name: h1 Gl _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �l�/Ql [�r�lL'!ti'�'Yt Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [—] c [—]' [_] Longitude: [� ° [� ' [� «
Design Current
Swine Capacity Population Wet Poultry
Design Current
Capacity Population
Design C►urrent
Cattle Capacity Population
❑ Wean to Finish
❑ Layer I
I
i Cow
❑ Wean to Feeder
JEI Non -Layer I
i Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
El Layers
El Non-Laylletsers
❑ Dry Cow
ElNon-Dairy
El Farrow to Finish
Cl Gilts
❑ Boars
Other
❑ Other
El Beef Stocker
❑ Beef Feeder
El Pullets
❑Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑ Other
Number 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 ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[I No
[I NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3
%%G - %70 -- C'C' 3C
12128104 Continued

Facility Number: S Date of inspection (f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Struct re 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
No ElNA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
JV
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesP
No ❑ NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
Cl Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
f
❑ 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
t2. Crop type(s)
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
``ILJ No
❑ NA
❑ NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fo
0 No
❑ NA
❑ NE
Z /X P�-' le, G e
Reviewer/Inspector Name ,/ /1 CIO Phone:
Reviewer/Inspector Signature: Date: /�
Page 2 of 3 12178104 Continued

Facility Number: — Date of Inspection l G
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ONo ❑ 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 VNo ❑ 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
VfNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Vj No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Cl 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)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
m a, w
A i iI-C6m_mints:andlor Drawn s
14
AL
igl,�31(uf
El9/11 g I S
a I/a s, r. 3
oc^ _ 91 free 1i7V,1'1 level' W 11 f
C.r U 1 Cf 41G,'j �s �/c ow i
C �V yo 9-t C O�
4j d k s
�� /� �
t'�
Page 3 of 3 12128104

410
Type of Visit (; ,ftmpliance Inspection 0 Operation Review 0 5trugture Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral jAmergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time:
A
re Time: County:
Owner Email:
Phone:
Facility Contact: Title: Phon No:
Onsite Representative: Le.G% Integrator
Certified Operator: Operator Certi ation Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Region:
Latitude: = o = i = Longitude: = c ❑ 4 = If
Desi=CE-grent Design Current Design Current
Swine C*apacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Layer 1
❑ Daia Cow
❑ Non -La er I
I ❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Dairy Heifer
pry poultry ❑ Dry Cow
ElNon-Dairy
❑ Layers
El Beef Stacker
❑Non -La Non -Layers
❑ Pullets ❑ Beef Feeder
❑ Beef Brood Co
❑ Turke s
❑Turke Points
10 Other Number of Structures:
❑ Boars
Other
❑ Other
Discharses & 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 7No ❑ NA ❑ NE
❑Yes
El No
[3 NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;dNo
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facili Number: a
ty 3 '- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes ' No
ElNA ElNE
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):
Freeboard
Observed (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes C;] No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �No
El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA Q NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [XNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ;;?No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
1❑ No
❑ NA eNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA �nNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA ICI NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA �E
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):
• a� `/ -fin a6�u %r1�)�` �'��,- 4� : 141
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
r-
lsiZaiu4 c,onanuea

' Faciiity Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ONE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ No ❑ NA VNE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ;2i4E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No ❑ NA -I NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA VNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
[DNA
ONE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Y
1�I�
NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
0 NEB
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
VNE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permi
or CAWMP?
El Yes
ElNo
ElNA
PNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours andlor
document
❑ Yes
❑ No
❑ NA
V�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
�kNE
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
General Permit? (ie/ discharge, freeboard problems, over application)
JVNE
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
ONE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
CNE
Additional Comments andlor Drawings '
bwe �lo p CL l fo ,bw kel I2
Page 3 of 3 12128104

le —
Type of Visit 30rcompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: ! Region:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: _ -�_ /ls �f� Fc,rt� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E=1 e E=I , E:J „ Longitude: [= ° 01 0
fA
Design Current
Design C►urrent
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
❑ La er
❑Non -La er
Cattle Capacity Population
❑Dai Cow
❑Dai Calf
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish
/,
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Turke s
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
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 l of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection G
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
Stru re 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): io
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
l t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[:]No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
.Comments, (refer to question #): Explain any. YES answers and/or any recommendations -or any other comments
'Use drawings of facility to better explain situations. (use additional pages as necessary):`
F-Fariw ! S /i? Jv o a e- e Cor S ea O
Reviewer/Inspector Name � LI Phone: YG �d�Z
Reviewer/Inspector Signature: — Date: ci0
Pape 2 of 1212 104 Continued

Facility Number: Date of inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑Other:-
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield Cl 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the 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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
1
Page 3 of 3 12128104

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit OrRoutine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /8 64 Arrival rime: �-� 0 /!� Departure Time: County:
Farm Name: Owner Email:
Owner Name: Ze c/_ ZIX I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: e5
Certified Operator:
Back-up Operator:
Location of Farm:
%Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region;
Latitude: =o =, =1 Longitude: E--10=' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattie
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 15
Farrow to Wean s
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes '0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
A No
ElNA
❑ NE
ElYes
IxNo
❑ NA
❑ NE
12128104
Continued

J t-
[Facility Number:,3/ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Sure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?: Nfl
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
9No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
10 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
VNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VfNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
gNo
❑ 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 AcceptableCropWindow D/ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s) q��O A , d A
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
,21No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
�?No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA ❑ NE
�� ��' �a2 � G�o`� C��or � y ��� r✓ s !� .o B�� r_--� �i��,g y.�� �� G��
�D/�i �d ki I.JG /11G`P�D / irwu�l� /ems' l�u`af5 /w, ��o.✓ ,�
Reviewer/Inspector Name �, ���.s ., Phone: OAK -7�lv
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of InspectionI
R_eauired_Records
& Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
(P(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 appropiate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo ❑ 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
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PrNo
❑ 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
to
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE-
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ONA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
I/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
El NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
/�
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,/
�d No
❑ NA
❑ NE
12128104

Dxvrsron of Water _ µ
�° " -- � =» � � -� � �,� 0 Drvrsldn;Qf Soil -and Water C.OIL4e�1 V9t10II .? � _ � �- "`��.°t' � �. •�
Type of Visit /5 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit.: S i isne: `.]CJC7
Not O eratioIIal O Below Threshold
XPermitted MrCertified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..... ..........
Farm Name: ............r ,.a..... S .......... - - County: ....».................. .... ...................
OwnerName:....__._._.........._ .......................... _ ... Phone No:...................... ... ......_.......__.. .......
NtailingAddress:........................................................................................................................................ --............ --..................... ... .................... ............................
Facility Contact: .......... - - -- W._ Title:.._ .. W.._ Phone No: _._-
Onsite Representative:..1Yi�A ,....1!-....._...I............................ Integrator:......................................
Certified Operator:... ..... _ .. _.� ..... , • , ...... W Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 44 Longitude • 4 96
r
_ Des�gu v Current` `Design Current - Desrgn ; Cnrient
.-
^. a r
Po 'iiiiation. ,-.Poniry aei1?o ulation ace alabon.
;Swine -: -.Ca a
RCattle w _g w'°Po
Wean
to Feeder
eeder to Finish
—
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
�s D0. WS
Discha es L- Stream I�mvacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field I-]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) El 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) El Yes LEl No
7
2. Is there evidence of past discharge from any part of the operation? ❑ Yes o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _.__......�--•_...._... .... - ___ ....M..... ... __......
Freeboard (inches): 3
12112103 Continued
Discha es L- Stream I�mvacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field I-]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) El 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) El Yes LEl No
7
2. Is there evidence of past discharge from any part of the operation? ❑ Yes o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _.__......�--•_...._... .... - ___ ....M..... ... __......
Freeboard (inches): 3
12112103 Continued

Facility Number -- :e;79 Date of Inspection (o O
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?
❑ Yes Q'NO
❑ Yes o
❑ Yes 0
❑ Yes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Apnliration
10. Are there any buffers that need maintenance/improvement? ❑ Yes o
11. Is there evidence of over application? If yes, check the appropriate box below. ElYes o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C, S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes g;;O��
Z
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes 0
15. Does the receiving crop need improvement? ❑ Yes '�'�'�
16. Is there a lack of adequate waste application equipment? ❑ Yes l 0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes o
Air Quality representative immediately.
Figs S 4 ! co zD$
Oo PT G5 5-& t_ Jrs-r
Reviewer/Inspector Name
Reviewerftspector Signature:
MOO G �o OpLee-
'3 ryo ti-ra S ) �O Lacs
❑ Field Copy ❑ Final Notes
Date:
lW t L/VJ a.Vlssus�[G{i

Facility Number:
r
Date of Inspection a
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did ReviewerAnspector fail to discuss reviewfimpection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33_ Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ONO
❑ Yes No
❑ Yes o
❑ Yes ao
❑ Yes ;"
❑ Yes
❑ Yes Leo
❑ Yes 0'No
❑ Yes L'J �O
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:
10 Not Operational Q Below Threshold
Permitted 0 Certified M,' --,Conditionally Certified D Registered Date Last Operated Above Threshold:
Farm Name: U)
n County:
Owner Name: _ �! � usq '+j �S Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: M,=(`r�NEL�'S _
Certified Operator:
Location of Farm:
Phone No:
Integrator: 4
Operator Certification Number:
[A Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 0° " Longitude ' ° �K
Wean to Feeder I I 1111LJ —Layer §[L-j D
Feeder to Finish r% _ ❑ Non -Laver ❑ N
Farrow to Feeder U Other
Farrow to Finish
Boars
No Liauid Waste
Present
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potentiat adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes P�No
❑ Yes 10 No
❑ Yes ZNo
Structure 6
Identifier:
Freeboard (inches):
0510310-1 Continued

Facility Number: — fpZ Date of Inspection DZ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ElYes gNo
(If any of questions 4-6 was answered yes, and the situation poses as
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? El Yes INo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application /
10. Are there any buffer; that need maintenancelimprovement? ❑ Yes ONo
11. Is there evidence of over application? Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 'ONo
12. Crop type
13.
Do the receiving crops differ with th6se designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
/❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
�No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
0No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El
o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
7o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
El Yes
,_,(
E No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
o
X__�
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�(No
0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
�U JI: urawiugl Vl lalliily W UCLLCF_VAPA alil �iLuialiulla.,tu�C nuulLlVLLill�tln 'C3-a] urt.C3saCy j
+.�. �., 01 - Field Copy Final Notes
15) 1\ F-cu1
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F �F
�F PO RT
CNt-Lf' (J FOR I , S jrJS/A C
N'r k i ME
Reviewer/Inspector Name F AE
r
°`
Reviewer/Inspector Signature:
Date:
05103101
Continued

Facility Number: Date of Inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 4 No
❑ Yes 51No
❑ Yes /No
❑ Yes ANo
❑ Yes Y—No
ElYes No
Additional .Commentsandlor Drawings,, 'ramp,
I�EJ�� I� �r✓R�{ C+��G �Ls� -��l ©A DE/9,� �ECoRQS OfnPL 7F
05103101

Type of Visit _oCompliance Inspection O Operation Review Q Lagoon Evaluation J
Reason for Visit ORoutine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Aceess I
Facility Number Date of Visit:
13 Permitted 0 Certified © Conditionally Certified 13 Registered
FarmName: ......... sr� W.. s �............................................................................
Owner Name: . J ���I. ,��k"1;r- .±---MS
Time: r
Not Operational O Below Threshold
Date Last Operated or Above Threshold: ......................
County:V� r
PhoneNo: ................................................. ........... . ... .. ..
FacilityContact:............................................................................... Title: ....................................................... ......... Phone No:
MailingAddress: ...................................._................................. .....
Onsite Representative:.st...A.�..r—"eL......N o rrj l Integrator:.....�.vrr-I .... ................................... ............ ..
CertifiedOperator: ................................................... ............................................................. Operator Certification N ber:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �4 44 Longitude �• �4 �u
Deli Current " Desi Current Desr Design Design gn Current
Poultry ton CttCaci Population. Ca ch Po elation
❑ Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
Farrow to Finish ToW Design CAPacity
Gilts ^
❑Boars Total SSLW
Number -.of Lagoons 1 ❑Subsurface Drains Present ❑ Lagooa Area ❑Spray Field Area Fie
Holding Ponds I Solid Traps; ❑ 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 discharge is observed, what is the estimated flow in gaUmin?
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
❑ Yes )ZNo
❑ Yes)?No
❑ YesNo
❑ Yes XNo
❑ Yes �No
❑ Yes ),,fO
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes / �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................... .......................... ................ .................................... ....................................
Freeboard (inches): 38
5/00 Continued on back

{
Facility Number: 3—, Z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes J?jrNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes f�'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/itnprovement?
❑ Yes ZNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes j�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ETNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes Ao
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes �ZNo
12. Crop hype F_eS , ye g rA 2_ , GO r►'t , U f e't�►1oy b ec, y � _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes 12'No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
j2ryes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes )dNo
Records & Documents
_Required
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes )ZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes''No
(ie(WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ;3No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes �No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes �No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
J,
24. Does facility require a follow-up visit by same agency?
❑ Yes F1 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes//04o
yioi�t>iignjs:o� dfrf�c�enct vtre nQteel dltritig 4hjs:v�s�ti Yo> w1;eeiyeo fut�thtr,
cotrres deuce: about this visit:
.omments (rater tr�;:gaestiv�f #}-E�cplatii�any-YF.S answers and/or aruy recotnmendahans ofany other coiunents. r
use drawuipotytoiter.'eaozcs
115. Fee,scue e-Polo rrce437 ��*�+Pro✓e�¢nf . me' No.-f15 Says
al ►' SGec{ re 14trf ad 41JS A [ 1
Reviewer lns ector Name s P`
P SIm�tvq! _
Reviewer/Inspector Signature: Date:

Facility Number: 3 ► —s/o 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 ❑ 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,^
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes j�No
roads, building structure, and/or public property) /
29. Is the land application spray system intake not Iocated near the liquid surface of the lagoon? ❑ Yes�10o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or J
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �j No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j2<0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
[Addi
bona omments an or: rawings• _ _ r
a
- - - - I IWI
5100

•;J
<-Qua
� _ n _ Z _ - — n t '�' �1'•Y-,
�•`! ',. Division of Water_ Quality'y„!
Q. Division of Sod and Water. Conservation y ,Y
k k
QOther Agency
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number s Date of Visit:
[j Permitted Certified Cj Conditionally Certified © Registered
Farm Name: S
Owner Name: ............�... F.. �............ .
Facility Contact:
"Title:
FlailingAddress: ..............................................-..-................. .
Onsite Representative.......�Yi.'.G �.�.2.. 1Y-C1- � �.-5..
Certified Operator:
Location of Farm:
Printed on: 7/21/2000
0 Not Operational Q Below Threshold
Date Last Operated or jAbove Thresho�ld�:f .-......................
County:....:P.u.A�:.h.......................�'.`... ` .........
PhoneNo:. ................. .......................-...........
Phone No :..........:...
Integrator: .........
..............................
••••-•,•••.................... Operator Certification Number:
ne ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ! C�:; Longitude & ° C «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy I I —]
Feeder to Finish I SIC) ❑ Non -Layer I ID Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ soars Total SSL W
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-,,n Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream 3mRacis
I. 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. Il'-discharge is observed, what is the estimated ilow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �<No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J`C " o
SITUC urc I Structure 2 Structure : Structure 4 Structure S Structure 5
Identifier : .......................................
Freeboard (inches): S-
5/00 Continued on back

Facility Number:S( -- �(�'L Date of Inspection -Zci• Printed on: 7/21/2000
>7 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? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type i-e,!S, LA-7 C, t ✓ I► �. [
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? (le/ irrigation, freeboard, waste analysis & soil sample reports)
20- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21- Did the facility fail to have a actively certified operator in charge?
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
24- Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: 10 yWhtions:or• & cWhi,_j s were noted- ditrifig #his:visiC • Y:oi} wii! receive Rio further • : -
roues• oridence.about:this visit. ::::::::::::::::::::::::::::: :
Comments (refer to.question #): Explain any YES answers and/or any recommendations or any other comments.
Use. drawings of facility to better explain situations. (use additional pages as necessary):
7, Cros;&ri c..kk., C/IG5&on/e5pec-,ei1ly eorriprs Y!te 4-v be- r[p�.,-mil ctho( ser�le
❑ Yes>(No
[]Yes PNo
Yes ❑ No
❑ Yes *0
❑ Yes CVO
❑ Yes N0
❑ Yes No
❑ Yes 1XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes >No
❑ Yes 9No
❑ Yes )No
❑ Yes YNo
❑ Yes VINO
❑ Yes �­No
❑ Yes �(No
❑ Yes �'No
❑ Yes I No
❑ Yes [ P4o
❑ Yes �No
Reviewer/Inspector Name iZ J SS
Reviewer/Inspector Signature: Date: ) - Zo'do 5/00

F,pcility Number:.3 — j Date of Inspection Printed on: 7/21/2000
r Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor hvlow Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes rNo
5100

O ffivrsron of.SoiI and; Wateir. Conservation_, Operation Review -
©,Iiiviston°of Soil and Water Conservation. --Compliance Inspection
[&,V'ision of Water Quality- Compliance Inspechou a
Other Agency Operation Review
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number `3 Date of Inspection
Time of Inspection 00 24 hr. (hh:mm)
0 Permitted 9Certified 0 Conditionally Certified 0 Registered 10 Not Opera Date Last Operated:
Farm Name: ��` County:......-Q-�.. \tom
....................................................................................................................... �.................--............................................
OwnerName: ............................................. ..................................................... Phone No:.............................
FacilityContact: .............................................................................. Title :......................................................... Phone No:
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative: aG� ... S „- . Integrator:...... � ��1��..................................................
Certified Operator : ......... .......................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
[latitude 0 4 .4 Longitude 0 ° «
Design.,_ -.Current- Design Current Design Current
Swine. Capacity- Population poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish ❑ Non -Layer I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity-
r.
❑ Boars Total SSLW
Number_of Lagoons' ❑ Subsurface Drains Present ❑ Lai2oon Area ❑ Spray Field Area
- ,
Holding Ponds / Solid. Traps ❑ No Liquid Waste ivlanagement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'!
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in 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
A:
Cl Yes j No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes kNo
❑ Yes N No
❑ Yes 6040
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LL{{
Freeboard(inches) . ............. .1.:3.............. ................................... .................. .................. ................................... ................................... ...................................
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes nj(No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 a Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public -health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require main ten arce/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 evident f over application? ❑ Excessive Ponding ❑ PAN
12. CF tYPe TP . � , fG -- ki ! } f \.
13. Do the receiving crops differ with►those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Nd-yi6 atioris;ot- & cientk� -were noted- dikrxrig Phis;visit: - Yoi} 'Wfl1.i-&6*46 Rio fui-thef.
corresp6fide... about. this visit... . . . . .... .
mments ("refer to question #) Explain any ITS; answers and/or any recommendations or`any-other comments.
e drawings of facilrty toTbetter ex platn-sttuations (use additional -pages as necessary} P r
❑ Yes NrNo
❑ Yes XNo
❑ Yes 01 No
❑ Yes Wio
❑ Yes JXNo
❑ Yes 9No
❑ Yes P(No
❑ Yes j(No
❑ Yes (WNo
❑ Yes [XNo
`Yes ❑ No
❑ Yes XNo
❑ Yes VNo
❑ Yes NrNo
❑ Yes O7 No
❑ Yes [�(No
❑ Yes &0
❑ Yes UrNo
❑ Yes 0 No
❑ Yes ONo
❑ Yes XNo
�e-�� �--I � i. ►-YES-�a'�� ��>�� �� �, �,,�- �•-.�� ��►�e�
�po
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Fad ety Number: — a Date f11 111tipeC tli)El t 1l Lb t { t
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
eyes
❑ 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
9No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
KNo
roads, building structure, and/or public property)
29,
Is the land application spray system intake not located near the liquid surface of the lagoon?
ElYes
,�j No
30,
Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
ElYes
�rNo
32,
Do the flush tanks lack a submerged fill pipe or a permancnt/temporary cover'!
❑ Yes
ErNo
3123/99

:n=..s.ar,<>Qvm= .
Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
n k �
w.
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection b �
Facility Number 31 Sb -
Time of Inspection �� 24 hr. (hh:mm)
Registered 'P Certified © Applied for Permit 13 Permitted Not Operational I Date Last Operated:
Fares Name: County: ...... �u��:.h....................................:.........................
Owner Name :....................... tufV4�.'U..... Rm w....... fv..oc................................. Phone No: i 10 .-.2i.S.� .........................................
Facility Contact: ............. C.L16....... 5. �"Qx i ................... Title:
MailingAddress:... b......... a,7c........ .�� ......................................................
OnsiteRepresentative: ............ ..GLWtt. ar,,........... S51
Certified Operator. .......................
Location of Farm:
Phone No:
c?Ac....f 1. t.i...r................................. ... 7-Nq......
Integrator:.................................................................
Operator Certification Number: .........................................
......... C1b...5 .Sa - ...A...--Y...I.°IK 0-...Xxilz�.........oje•ak....-_a..-...-.�1.......................................................................................................... A,
................... ..._ ....... .. .........-.... ........ ....... ,
Latitude =• 0' " Longitude • =` ="
Design Current = Di sign Current
Design Current
Svnne'°J _Capacity";Population ; Poultry a Capacity Popuiattan° Catile ;
Capacity Population
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish ❑ Non -Layer El Non-Dairy
�r
µ. ❑ Farrow to Wean
❑ Farrow to Feeder jE1 Other
❑ Farrow to Finish STotal Design CpaCliy
❑ Gilts 4
❑ Boars -1 Total SSLW
t,
Number of Lagoons / Hol_din Ponds - Z� '
ID Spray Feld Area
❑Subsurface Drains Present III]
Lagoon Area
.z
x :.
... .... .......
W
❑ No Liquid aste Management System
v
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes IS 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 ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 0 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. No
7/25/97 rr

41 Facility Number:
8.
Are there lagoons or storage ponds on site which need to be properly closed?
Yes
❑ No
Structures (Lagoons.Holding Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: i nxc].. ............... ....................................... �Ib ............................................................................................................
...................................
Freeboard(ft): ............... :.-.1.......... ..._................................. .................................... ....................................
....................................
............ ,.......................
10.
Is seepage observed from any of the structures?
❑ Yes
[5; No
11,
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...........� r.,..er r..............�aS.ug.........."k. ............. Cam ... ..... W. to, ......... 1�_'aqr6c...................... .........................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
q No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
P4 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
M Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
0 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
99 Yes
❑ No
0°N.violationsor. deficiencies:were notedduringthis:visit. Yoiu,will receive'noltirtliei~:
::-::�:::-:-:-:-:-:-:::�:::�
C•flla [6yo" 5"W be �raear� GloSct�. Aiaro�rcak jar Wha
OrVC ''"d bQ S���^:ntU �c Z)WQ.
lz, 1►+_lt� �,l�c or. ►•xw �u�jloar S tJ 6. ex e�
i�. Grscue c ria� ��. �teSt) S ! `� tky ghaNlci he rt�'�rove� �n:SIl T e1ic. �eeeJ rwa�w5e
�Qrn.U�o- C� �rt�dS Ftr3 �#' �S g�ov� lae .-m�novc*J S�nF� vtg + e.X• Weed '�`��3e!
Uiar c_V1i/Src►z1�•
2 _ 5 recvr3s r . e1J s�oA be4�&Ow;� O.. � OTri "F Cxeper-� a pre5er �C ,ro w ti xazo nv S� e�w�
5P' �i `9 i o Jug 'gS Sha�lc� f�� co►n6a�nt} or � 10.R a. s1�+ 1. � �
uXc, C9v�erwan`�ca'�'iar� 4n��ra��r� ari �CSCUe �^ �;e�d 2 P-A - ��'4o l+n/4c. avtr. 7/2S/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 1 Date:

t
Owner Name :................................................... Alurp412may.farms....................... Phone No: 4.10..289-2111...........................................................
Facility Contact: C1aylan.S.ullart.............................................. Title: .lY1211dIgex........... ................................. PhnncNo•
MailingAddress: P.O. Box..7S9............................................................................................ Base.lI111..P.IC........................................................ Z8.458 .............
Onsite Representative:,1a1110..B1ZifG..C1ay.1A.TA.S.ullalu�.Tam.B.e11............................ Integrator: Mu.Cphy.Fwally.Xitruis.....................................
Certified Operator:11mmas_W............................ Ben ..................................................... Operator Certification Nuinber:.17.7.9.8 .............................
Uwation of Farm:
Latitude 34 • 49 40 Iwmgitude 77 • 5s 10
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. il'diseharge is observed, did it reach Surface Water? (Tfycs, notily DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes H No
❑ Yes ® No
Not Aoolicable

Facility Number: 31-562
8. Are there lagoons or storage ponds on site which need to be properly closed?
N Yes
© No
Structures (Laeoons.Iloldinit fonds, Flush Pita etc.
9_ Is storage capacity (freeboard plus storm storage) less than adequate?
El Yes
® No
Structure 1 Structure 2 Structure 3 Structure 4 Stn[CturC 5
Structure
6
Tdcntificr: ,..........A��Yg .................t bdad{}AIed....................................................................................................................................................
Freeboard (fi): ............2A.R....-------- AL.
....................
10. Is seepage observed from any of the structures?
0 Yes
® No
11, Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
N No
12. Do any of the structures need maintertancerrmprovement?
® Yes
© No
(]If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15, Crop type ....................... ftao§...................... .... ..................... RyQ................................. CA.aStal. CUUMda..CTEasS...... .................. (al1.gr=-4...........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
N Yes
© No
17. Does the facility have a Iack of adequate acreage for land application?
❑ Yes
N No
18. Does the receiving crop need improvement?
N Yes
© No
19. Is there a lack of available waste application equipment?
❑ Yes
N No
20. Does facility require a follow-up visit by same agency?
❑ Yes
N No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
22. Does record keeping need improvement?
[] Yes
N No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
N No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
0 No
.l.. vio. ...s...d'eficiert�.... ...o...... tlis-visit.: .•rarl�•r....e......er
. • .Ckres�oudence ihouf this:v siti :..... ::::::::::::: :
5; & 24. Since NCDWQ visit 11/14/97 new fence installed between dead box area and adjacent drainage ditch. lids obtained and
sed for all boxes (as needed). Hogs are no longer buried on site - all carried to rendering facility. Open pits for burial noted during
1CDWQ visit has been covered. Dead animal disposal facilities appear greatly improved.
. Abandoned lagoon on site. This structure should either be properly closed (following an approved closure plan) or managed to
revent any discharge. If structure is not closed management strategy should be documented in waste utilization plan. Contact technical
pecialist for approved closure plan or revision to waste utilization plan_
2. Area between swine house and active lagoon should be graded, stabilized, and seeded to allow storm water proper diversion. This
cork is scheduled to be completed by 3/l/97.
.2. Map has been redrawn outlining pull numbers as related to field numbers. Soil samples to be pulled by 12/31 /97. 7/25/97
Reviewer/Ins ectorNamett,
...............
p >:::<.:
ReviewertInspector Signature: _ Date:

Facility Number: 31-562 Date of inspection F 12/17/97
& 18. Coastal bermuda to be sprigged/planted in field #3 next spring. Rye has been planted in field #3 as indicated in waste
zation plan. Fescue in field #3 to be eliminated as part of appropriate cropping plan All spray fields grazed.

��,
❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
18-Routine O Conmplaint O Follow-up of DIVQ inspection O Follow-up of I)SWC review O Other
Date of Inspection it o 4 4
Facility Number
Time of Inspection D 24 hr. (hh:mm)
0 Registered ® Certified 13 Applied for Permit 13 Permitted 0 Not O cratianal Date Last Operated..,........... p �,
c
Farm Name: .? County:..D.i1 .....................................�.;.
1
Owner Name:....A.tt.-rtjj �0..trYt .i..� �a .✓�,rx .i................................ Phone No: � .......... I.............
Facility Contact: ...._.. ..... Title: ..................� {{ .. Phone No:
Mailing Address:.. �9,�.e ...f? i.�..........��C.
.... ID Bd y.--............................................................................ hIL Y.
OnsiteRepresentative: ......Dy X....g .�.�.. iA,.�,i ..�.�. .,ti... Integrator:...�j,���
..............................................
Certified Operator:.... .......................................................... ``� Operator Certification U her,........................................
Location of Farm:
Q,�...5.�..5 ....5.�...... Q......5...........i ..... �.....n..P.aa.x �.. :.Ct
.......rn..,...L.� ,C.....1 £. L.�..... R .......1 !�.
$A
. i..a........w.)JU.�.....�1..l....I),.............................I....
Latitude • 0' " Longitude • 4 "
Destgn ` CurrenE. =�."Design Current. Desk `Current
, Sivtne -'
Capi(o*y�,Pppulation _ Capac�Ey Populateon Cattle - Capacity 'Population
.,
,Poultry
❑ Wean to Feeder
JE1 Layer I I❑ Dairy
Feeder to Finish
JE1 Non Layer I Non Dairy
s ❑ Farrow to Wean
Farrow Feeder
❑Other
to
a
❑ Farrow to Finish
T©tal Design`'Capalb
❑ Gilts
�10 soars
` ' 'Total SEW,,
Number of eons / Ho1 Poncls ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
l
a
Liquid Waste Management System
❑ No x
im
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes C?No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. if discharge is observed, dill it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?JA
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ayes ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require CRYes ❑ 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 6No
7/25/97 Continued on back
LvZ�z

of Facility Number: — rj
8. Are there lagoons or storage ponds on site which need to be properly closed
Structures (La2oons,tioldina. Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less t n adequate?
Structure 1 Structure 2 Structure 3
Identifier: . fn
Freeboard(ft):.....................................................................................
10. Is seepage observed from any of the structures?
,Yes ❑ No
❑ Yes 54 No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..4N..� ........................
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?
:3-No.vio'iations-or deficiencies.were h6ted-durittg this:visit:• You'.will receive•no-f1irther-:
-•correspondenceahautthis:visit:-" ..•.�.�.•:.•�•. .�. .-.�.��•.•:•..:�..�. .•:-.•:•. .�.... .�. .�
❑ Yes ® No
H Yes ❑ No
Yes ❑ No
❑ Yes W No
❑ Yes &No
RYes ❑ No
❑ Yes BNo
aYes ❑ No
❑ Yes ®,No
[i Yes ❑ No
❑ Yes Q No
Oyes [I No
❑ Yes IR No
tffYes ❑ No
❑ Yes RrNo
Counts (refer<fo gyestton) ExplaEu any YES answers and/or any,rccomtuenclattous oany otber�omtnents�
1Use d�w��g�s of facihty�tt� better�ex pleat sttuahons {use addtticonal pages as �iecessary) � �� ;,
�� � ��`
tit. Hay c. a rw S S w z er ot, t en---C[. C, i we-q 2 t-4%+-S
pitQ i e ` b p v, lh w G DL i t " '%4 ay.2 V-a S cw�i kl I.-S.
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�Qi: buried
5- Hro� c.u-+rcaSSS w�'iv-e_ tin
[ o to Li o •� � r G.w. ✓U-wl d ► S� S a- � • i
8. Old �-q gar SU--a v t.d- ivx, `Lo ses o-vt o--r dkt r o-r
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l%,,L i, L6. r, k-e v LcL k t
7/25/97
Reviewer/Inspector Name ` �'"` x�
'h' �>� . 't-�i•�tt c.t.: r tom}.
Reviewer/Inspector Signature: Pate:
hm]

Iraciiity Number:.. )...... .5- 12e Date of Inspection: �t }
r
Additional Comments and/or Drawings.
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4/3©/97

0
E
•
Site Requires Immediate Attention: �D
Facility No. -62o Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS. SITE VISITATION RECORD
DATE: 3 , 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
Integratc
On Site Representative: r . -C Phone:
Physical Address/Location: S_I D6 -�g /99&�I r�
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 00 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 77 - �' -, Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have ff-i ' freeboard of 1 Foot + 25 year 24 hour sto= event
(approximately 1 Foot 7 inches) Ye or No Actual Freeboard: -2Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o N Was any erosion observed? Yes o T
Is adequate land available for spray? Yes or No Is the cove. crop adequate? Yes o
Crop(s) being utilized: _ terC.ue
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?r No �o�
100 Feet from Wells?4V or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spra- irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by roan -made ditch, flushing system, or other
similar man-made devices? Yes ors) 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:
Inspector Name '
1 cc:.Facility Assessment Unit
&0r9 a
S 1 -9 Zure
Use Attachments if Needed_
r '.