310599_INSPECTIONS_20171231

NORTH CAROLI NA
Department of Environmental Qual

Type of Visit: KCon ance Inspection U Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 / Arrival Time: '� p Departure Time: O County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: p Title:
Onsite Representative: 5-w — .e s f� 'j
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: n
Certification Number: J O 3 3 2
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
C►attte
Dairy Cow
Design Current
Capacity Pop.
an to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
y
Design Current
Drr P,ouItr, Ca aci t o
La ers
Non -Layers
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Boars
Pullets
F—r7ther
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ado ❑ NA ❑ NE
❑ Yes /Noo
NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of -Inspection: 12 / Y-/
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [E l"o ❑ NA ❑ NE W,-
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
El"Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes jrNo
❑ 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 ZfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes IVo
❑ 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
[�J '�
❑ 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
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Fj"No
❑ NA
❑ NE
Required Records & Documents
No
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
j'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
2 N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: r31 - 511 Date of inspection: L
4/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
P 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 I6
Ili
PA,¢ i(1 C lc c4'o^,C j r C a - d_S
List structure(s) and date of first survey indicating non-compliance:
C
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 G3 1""
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes EfNo, ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
VN
❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Signature: %(� `^' Date: )Z I l b
Page 3 of 3 21412014

6-
Type of Visit: aCompliance Inspection O O=oUow-up
eview 0 Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: p n�Departure Time: 'L.J County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine C►►opacity Pap. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . P,ouItry C_a aci. P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke PuuIts
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 ❑ D NA ❑ NE
❑ Yes o D NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
Page I of 3 21412015 Continued

IF^till Number: 3 _ IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? es ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No [] NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to.the integrity of any of the structures observed? [2-Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 0-No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [] Yes [] No ❑ NA �E
❑ 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
[2-NE
l5. Does the receiving crop and/or land application site need improvement?
❑ Yes
E] No
❑ NA
❑'NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
ENE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
EJ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
E INE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
�IE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
[] NA
[2-KE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps []Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [—]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes []No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No
❑ NA 0-NE
❑ Weather Code
❑ Sludge Survey
❑ NA NE
❑ NA VE
Page 2 of 3 21412015 Continued

.f
1;'acili Number: IDate of Ins ection: S
24. Did the facility fail to calibrate waste application equipment as required by the perm' ? t
Yes ❑ No ❑ NA
Q NE,
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ❑ No ❑ NA
❑.Ml�'
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
!
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes ❑ No ❑ NA
NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes - No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes e' o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes "o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 10 ❑ 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 E] o ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ]o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E5 No ❑ NA
❑ NE
Comments (refer to -question #):.Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings �o! t ilily, to,beiter explain, situations (useadditional pages as necessary).
C.nL �Qµrrdpf'ttl
anGr �f�nr��. �n�+�
-� ��lir�L►�
/), h4"-�C I��.
G.4­ e e o J.I h e ti�.c,t rf le u L--P- 5 LA'-X ' . 1P o
J
� �, '� r,T 1 1� �t li', 7 � �c.� G yc-.r� ✓✓ T � ¢- � h� �` % L�
Reviewer/Inspector Name: 1 I � � o L_�( �1
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /
21412015

type of visit: ;7`utine
nee Inspection Operation Review O Structure Evaluation .0 Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: t yP Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �(� +� L ,�7� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pap.
Wet Poultsy
C*apacity
Pop.
C-attle Capacity
Pop.
can to Finish
Iluayer
Dairy Cow
can to Feeder
Non -La er
DairyCalf
Feeder to Finish
$
Dairy Heifer
Farrow to Wean
Design
Current
Dg Cow
Farrow to Feeder
it.
Ca acit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
I
10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No 0 NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

If fj
Facility Number: 3 Date of Inspection: ? O
fVaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I
Spillway?:
Designed Freeboard (in):
�+
Observed Freeboard (in): �
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
Structure 5
Ef'No ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8, Do any of the structures lack adequate markers as required by the permit? [:]Yes Xo
❑ 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
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yeso ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17, Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
0
❑ NA
❑ NE
❑ Yes
TNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[] Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspection ❑ 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 21412015 Continued

Flgcili Numbcr_ 3 ( - 30,11 jDate of inspection- l
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ es
No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions relate 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ENA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
C21 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
d 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
0No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tiie drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E�/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
o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to gsiesti6n,#) Explain any,YES answers and/or: any, additional recomtnendations or any other comments. -
Use•drawmzs}of fac�lrty$to better e`xplain,situadons`(u'se:additional pales as necessary).
S ) e- � 9 A- A , " P y 4 0 C-V'.
R. IL �✓ o n 1 P s t,q
4L•
�tn,o vK e r no �� �n✓a I �G Q po
i'4L L-� Q ��
Reviewer/inspector Name: ' f Phone: rn M 7 30 Y
Reviewer/Inspector Signature: Date: r J 7
Page 3 of 3 Ll 21412015

Type of Visit: compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: `Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3 ` S /j/! Departure Time: County: Region: W
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator:'S�ke4nCertification Number:
A�)�q� 5
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Desigurrent Design Current
Wet Poultry Capacity n CPop. Cattle Capacity Pop.
La er DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
=Design Current Cow
Dr. P,oul C•_a aci P,o . Dairy
Layers Beef Stocker
Gilts
Non -Layers
LNon
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
r
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No, ❑ NA ❑ NE
❑ Yes in No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fa_ Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ;P!rNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;eNo ❑ 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 eNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes /No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �rNo ❑ 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
,5-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E2f No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VrNo
❑ NA
❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
pro
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Po
❑ NA
❑ NE
Reouired 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 7No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste T nsfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 04 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VrNo ❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

facdiiity.Number: - DaInspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesP'INo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Jj No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #1: Exnlain any YES answers and/or any additional recommendations or any other comments.
of facility to better
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
situations (use additional napes as necessarv).
❑ Yes /No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Phone: p�3bi��n
Date: J
2/4/2011

type of vjsit-.--Zk Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: XRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: %7 Arrival Time: ® Departure Time: ® County: 4 ] ,,( x Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: Lpm P-s integrator:
f} Po Pass Certified Operator: S 1 e0jj6 1 Aqe Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
C*attle C*apacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
gC) 55
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,ouI
La ers
Design
Ca aci_
Current
P,o ,
Cow
Non-Dai
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys___
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 1�pfNo ❑ NA ❑ NE
❑ Yes 1�o ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility •Number: 3 - CjGj Date of [ns ection:
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 [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Cq�
Spillway?:
Designed Freeboard (in): q ,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes *No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 j No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes O'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window �+ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Lstti-�+� JC
13. Soil Type(s): / in H
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V.
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�&No
❑ NA
❑ NE
acres determination?
�`
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XWo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists ©Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No [_]NA ❑ NE
0 Waste Application +❑ Weekly Freeboard ❑Waste Analysis Q Soil Analysis ❑ V, �6 Transfers Q Weather Code
0 Rainfall ❑ Stocking 0 Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections ❑° Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -q jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes No NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes No NA NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey Failure to develop a POA for sludge levels
1] Non -compliant sludge levels in any lagoon 1
77�� List structure(s) and date of first survey indicating non-compliance: ccolI _ j I_— 9 9 ) o
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes I XI No NA NE
, ILL] _[
o NA NE
��( t
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes No NA [] NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes t jNo [] NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) cert
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes T
ification?
� Yes � No
� NA
� NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
� Yes � No
[] NA
� NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
� Yes No
� NA
� NE
If yes, contact a regional Air Quality representative immediately.
� `
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
� Yes 4 No
� NA
� NE
permit? (i.e., discharge, freeboard problems, over -application)
3I . Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
� Yes �No
� NA
� NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.. I
Use drawings of facility to better explain situations (use additional pages as necessary).,
31�1ia o.sl
p)(0)o Cab
La-i C'�� �Mr-\[ I � S �Di�� ' ltE 11VSQ "0'V
SuS 'Q6 C o3 S i �(}Sz C
�-� %1� Alm ► m � ljo� �-15 C lnr7o CO �N
SD wl�L ��uG v�T►t_ 11�a�1�-To G%T EAU
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: � �16 -13c�
Date: �_—a
21412011

Type of Visit: Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: ` off'3 E J Owner Email:
Owner Name: S 1 a E �� Q MS , /,V C_ _ _ _ _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: --).A AA A nA iS Integrator:
Certified Operator: } F V 1 N T. � �� f Cerfificati n Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
q-2g.G-ZI S
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
5
Design Current
D , P,oul , C_a aci Pao .
DairyHeifer
D Cow
Non -Dairy
Farrow to Finish
La ers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
13oars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes No
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [—]Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes rNo
o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: 3 1 - G/ f Date of Inspection: i
Waste G`ollection &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?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes �% No ❑ NA ❑ NE
❑ Yes �'o
❑ 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 �P6,No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) (J��[
9. Does any part of the waste management system other than the waste structures require [:]Yes � X � No ❑ NA ❑ NE
maintenance or improvement? T-�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): R � _{14
A7
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 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ' No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP QChecklists 0 Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard Q Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Q Weather Code
Q Rainfall ❑ Stocking Q Crop Yield Q 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 21412011 Continued

Facili Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes A No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 1A Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon nn
List structure(s) and date of first survey indicating non-compliance:
[] NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes ❑ No X NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
0 Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
D Yes
No
VNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments ; -;
rL
Use drawings of facility to better explain situations (use additional pages as necessary). , r
p7
0- LIeR of
Reviewer/Inspector Name:
ReviewerfInspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Wil
FacilitvAtunbern -�
Dwilsion o
Type of Visit
mpliance Inspection
�Routlne
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
O Complaint
O Foliow up 0 Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: uN Region:
Farm Name: —CV "CL"Sr, s J Owner Email:
Owner Name: STAGE q--Agms. INC- (n�CPhone: 9 ►b - 5019 -5�+_41
Mailing Address
Physical Address:
Facility Contact: Title:
Onsite Representative: �m�cJ i�f� fYl Q
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = i = if Longitude: = ° = 6 =
ewn� Chu rent Desi n
Design Current_g
Cetrrent
wine-"
Capacity Population _�VI'et Poultry°;CapactyP P lation
xg
Cattle Capacity
Population
b; ❑ Wean to Finish ❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑Non -Layer
El Dairy Calf
Feeder to Finish
0�
❑Dai Heifer
Farrow to Wean
D Poult
El Dry Cow
❑ Farrow to Feeder
❑ Non-DaiEZ
.
a ❑ Farrow to Finish
x ElLayers
[] Beef Stocker
ElGilts
' ❑ Non -La ers
❑ Beef Feeder
'. ❑ Pullets
❑ Boars
❑ Beef Brood Cowi
-- F' ❑ Turkeys
Other
` [] TurkeyPouets
LEI
❑ Other
❑ Other
um of Structures:
_,ZN4.4er
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
/No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
o
[INA
[INE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
rNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facilif� Number: 31 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑NA [3 NE
❑NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Cct�Ti
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes XNo
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes l�¢ No El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)��.`f
6. Are there structures on -site which are not properly addressed and/or managed ElDQ 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
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes A
No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) pp,,��
9. Does any part of the waste management system other than the waste structures require ❑ Yes !l^�.No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No
❑ NA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 19No ❑ 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)
S
13.
Soil type(s) AQ 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
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
�6o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ANo
❑ NA
❑ NE
'Coniments (refer to question,#) ,' Explain any.YES answers and/or any4recommendat1ons or any ©ther�comments
41
.Use -drawings of facility to,belter explain situahbns (use addiiional pages as necessary) ssr � b
Reviewer/Inspector Name �!` E S. ,., Phone: 91 G JTF&
Reviewer/inspector Signature: Date:
Page 2 of 3 12/251W c,ontrnuea

Faciirty Number: 31 Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes
o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesNo El NA El NE
the appropriate box.
0 WUP [I Checklists 0 Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
[] Waste Application Q Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ V/aste Transfers ❑ /nual Certification
❑ Rainfall ❑ Stocking El Crop Yield ❑ 120 Minute Inspections ❑ Monthly -and V Rain Inspections ED Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
IsfNo
❑ 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
ANA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ 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
Page 3 of 3 12128104

Type of Visit 3ACornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit X.Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: MO QQ Arrival Time: ® Departure Time: County: N Region:
Farm Name: 1_0Q Is Sf� Hok_L5e -f Q Owner Email: n }
Owner Name: j IgzsTpcse_ Sqg-m5 / G nPhone:n T'
Mailing Address: P,d . l ox 4'3 9 CLily � Zw,, / v � COSS Q9
Physical Address:
Facility Contact:
Title:
Onsite Representative: mG S U)mz
Certified Operator: )�&ul^/ E
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 9 kgnls
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 4 = it Longitude: = ° = 4 = u
Design Curren#
Design Current
Desigo
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish I 1
10 Layer I I❑
Dairy Cow
❑ Wean to Feeder
❑ Non -La er I I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
ElPullets
❑Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Tur ey 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 N'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12128104 Continued

acility-Number: 3 1 - $t9Ql Date of Inspection n3b SO
Waste Collection & Treatment �(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ElNA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes []No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): OL EL
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 gNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes "❑ No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) J�
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 ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes ANo ❑ 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) Lj�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ 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?
[3Yes
No
❑ NA
❑ NE
LtJaold
%;,:-T song &PWS our of CAG4D)l 1W
Reviewer/Inspector Name Phone: tA-
Reviewer/Inspector Signature: Date: -7hn/a 9
Page 2 of 3 I2128104 Continued

' Facility Number: 3 ) —$99 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. 0 WUp 0 Checklists Q Design [] Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes *o ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ V/aste Transfers ❑/nnual Certification
0 Rainfall O Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and V Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NNo
❑ 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
0,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O(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
C(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
[I NA
❑ NE
Page 3 of 3 12128104

Facility Number 59
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
IType of Visit %Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit X Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: aY Arrival. Time: � f � Departure Time: County:
Farm Name: Owner Email:
Owner Name: Y�]C-l�?.�}fZ� t-+r.15�1\ Ta�rR�S7AG'E Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: \ / Title: Phone No:
Onsite Representative: J Q m G S-_ P mq:�,, Integrator: q
Certified Operator: r V & K)X Z-F-W ► ' 7 00 (L P c�� Operator Certification Number: ` � 34_1- -
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =]' =' =" Longitude: [� ° [ =
r< Design ''Current Design Current
Design Current
Swine Capacity `Population Wet Poultry Capacity. Population Cattle CapacityrPopulation
❑ Wean to Finish
11,10 Layer
}
❑ Wean to Feeder
� ❑Non -Layer
® Feeder to Finish-
❑ Farrow to Wean
i
Dry Poultry
❑ Farrow to Feeder
❑ La
❑ Farrow to Finish
ye
❑Non -La ers
1
❑ Gilts
❑ Pullets
❑ Boars
❑ Dai Cow
❑ Dairy Calf
❑ Dai Heifer
I
❑ Da Cow
❑ Non-Dairyj
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
- - - - - - - - ❑ Turkeys h -
Other. ❑ Turkey Poults -
❑ Other ❑ Other Number of Structures C
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 A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes
IkNo
❑ NA
❑ NE
12128104 Continued

C
F�rcilit}sNLmber: , —5�%q
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 9
Spillway?: p
Designed Freeboard (in):
Observed freeboard (in): (� O
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 DoNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 34 No ❑ NA ❑ NE
❑ Yes �(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 ONo ❑ NA ❑ NE
maintenance or improvement?
W-aste_Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes A No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PqNo ❑ 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
[KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ 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
E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Jallo
❑ 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): = g -
AL
Reviewer/Inspector Name ! A/ P S Phone:
Reviewer/Inspector Signature: kaaAa'1 • Date: elf
Page 2 of 3 12128/04 Continued

t�
Facility Number: 3 1 —�9517Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other �No
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ElNA ElNE
ElWaste Application ElWeekly Freeboard ElWaste Analysis ElSoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P 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
[j No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WrNo
❑ 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
CBrNo
❑ 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
4 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
[gNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
1� No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7Routine0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: o o Arrival Time: Departure Time: County: LUL- N2 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: -._Akq.S LAN48
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Title: Phone No:
Latitude: [:::] o
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish I K-'90 I 9T Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Nan -La et
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?
" Longitude: 0006 �46
Cattle
Design Current
Capacity 'Populations,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy'
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
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)?
4
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 LJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
L'� o
El NA
[I NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 - S45 Date of Inspection ,a 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P% 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: i Az."'J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,..�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R,No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) WNo
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ 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 environ ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? U Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ETNo ❑ 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 dNo ❑ 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 No ❑ NA Cl 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 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
VNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] yes
NNoo ❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
,
El NA
L��,Zo
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L ❑ 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):
L
er/lnspector Name �a�� Phone: (4id) %%`Ier/Inspector Signature: Date: Ia%1a'r o7
12128104 Continued

L1l
Facility Number: 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes /No ❑ NA ❑ NE
El Yes D No ❑ NA ❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking
E51/No ❑ NA ❑ NE
❑ Annual Certification
❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
El Yes
O/N(
El NA
❑NE
❑ Yes
❑ NA
❑ NE
ElYes❑
�;o
NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
Q,Pdo
❑ NA
❑ NE
❑ Yes
❑ No
dNA
❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes D o ❑ NA ❑ NE
❑ Yes I?No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes L`s No ❑ NA ❑ NE
❑ Yes(No ❑ NA ❑ NE
12128104

4SO"Division of Water Quality
Facil�'ty Number 3j S 0 Division of Soil and Water Conservation
- — O Other Agency
Type of Visit
Hance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
70utineO Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: $ o Arrival Time: Jd60 Departure Time: �] County: 0 I—T Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J AM.0 LAMP,
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ f ❑ « Longitude: ❑ o ❑ 6 0 «
Design Current Design Current Design Current.,
Swine Capacity Population Wet Poultry Capacity Population -Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
ER Feeder to Finish
-ft
Z.3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other,
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream lmuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
["No
❑ NA
❑ NE
❑ Yes eNNo ❑ NA ❑ NE
12128104 Continued

I
Facility Number: 31 — S Date of Inspection 8 0�
Waste C61lection & Treatment
4. Wstorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E4o ❑ 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: &Aesizo/J
Spillway?:
Designed Freeboard (in): `� T
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ 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 th at, 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 [?To ❑ 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 Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) NL_►�L �. E T C ,t J*
13. Soil type(s) 0 o rt.C4 L (Ci
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo ❑ NA ❑ NE
Z No ❑ NA ❑ NE
L�ivo ❑ NA ❑ NE
[3No ❑NA El NE
Comments (refer to question ft' Explain any YES answers and/or any recommendations or any other comments.,.-
Use drawings. of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I c* ( Phone: 6 .-
Reviewer/Inspector Signature: Date:

Facility Number: — Date of inspection
Reuaired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ErNo El NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes • NNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ CheckIists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /740 ❑ 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
C,_.2,(, o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E!rNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CJ
❑ NA
❑ NE
25.
26.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L
❑ NA
❑ NE
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
2 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
{n"No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ N
❑ 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?
[:1 Yes
L ]' o
❑ 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
9 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Lf No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NI:
Additional Comments and/or
Page 3 of 3 12128104

IType of Visit oCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Q! Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access (j
A 1
Date of Visit: C
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
County:
t r Email:
hone:
one No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = 1 ="
Longitude: = ° = 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
21 No
❑ NA
❑ NE
❑ Yes
FfNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection /
Waste Collection & Treatment / I
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier:/
Spillway?: A)p
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ief 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 PfNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 9Yes ,❑] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,�I No El 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 Arnllication
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 0No ❑ 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
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations
❑ Yes
No
YX_Z
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ YesNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
ElYes
No
❑ NA
❑ NE
7
7ti� /i/OTr%C'�D lii=� 'i ce ,�yOE vim- Zze
Reviewer/Inspector Name r ,�(% Phone:
Reviewerllnspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection' r �'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No ❑ NA [:IN E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ❑ NE
the appropirate box. ❑ WUp ElChecklists ElDesign El 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No
ElNA
❑ NE
ElYes No
El NA
❑ NE
El Yes /VNo
❑ NA
❑ NE
❑ Yes [;fNo
❑ NA
❑ NE
❑ Yes )�fNo
❑ NA
❑ NE
❑ Yes ❑ No /NA
A" E
❑ yes /ZfNo
❑ NA
❑ NE
❑ Yes 9No
❑ NA
❑ NE
❑ Yes VNo
❑ NA
❑ NE
❑ Yes /No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
Additional Comments and/or Drawings:'n :
..`� �
cc /t/ P,aD � i�c
a�q�
llaa,�,
❑ NA ❑ NE
12128104

`r
Type of I/isit er Corrlpiiance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Dther Denied Access
Facility Number Date of Visit: iP
Time: L_LL.� .J
ot rational C Below Threshold
Permitted dCerfifted 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ___ _'F= 233 a'3 E �M_ _ _ _ County: DIIAlbi......._ . _
Owner Name:
-Mailing Address:
Phone No:
Facility Contact: Title: . �Phone No:
Onsite Representative: D�E,f� ... Integrator: —1' _ .
Certified Operator:. , , . , _ _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Home Latitude • " Longitude . 4 �u
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑0NNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 7No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [I Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑Spillway ❑ Yes 0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Id tifier i
Freeboard (inches): L4 l
MUM Continued

Facility Number: 3 — Date of Inspection
1.
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes dNo
r seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes �No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ®(yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes [ /NNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Q N* o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes S
IN
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑11 Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type [i5W Y E
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes VN9
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes VNo
'
cre c) This facility is pended for a wettable adetermination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes lV<N
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 2'! o
liquid level of lagoon or storage pond with no agitation? �
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,L'3 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑Yes Ldivo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
.:<:3" 3 tt ka'. _ —fir
Commaents' (rder to q oxr,0} Eicglarn sny. �SWBlS sailor anyr ar anY�a
�f_ if useaddifiaaal'l�# � ry ❑Feld Copy ❑ Fnal Notes - �:.
7,) E*TC+Jo DO-AM0 P=Plr-- ZAM LA&000,
�.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 7 o %f
12112103 Continued

Facility Number: —5jj 1 Date of Inspection
k.
Rectuired Records & Documents
r
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ZNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
E3<90
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ekil o.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
12'No
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?
❑ Yes
Io
;X/o
(ie/ discharge, freeboard problems, over application)
❑ Yes
27. Did Reviewer/Inspector fail to discuss review/ mspection with on -site representative?
❑ Yes
/
B No
28. Does facility require a follow-up visit by same agency?
❑ Yes
O/No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
EJ/No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ I20 Minute Inspections ❑ Annual Certification Form
I2/I2/D3

Type of Visit 0 Com Lance Inspection O Operation Review O lagoon Evaluation
Reason for Visit :Zutine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Z. Date of Visit: 7 Z 9 Tune: Q 30
... 0 Not Operational Q Below Threshold
El'Pernutted ((Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: _.
Farm Name: iMIT 60-M _ _ - _ . _ W _ _ _ _. County: 1-AJ�U:Uj
Owner Name: , , . » .._..... _ . __. . , . .. 'Phone No:
-Mailing Address:
Facility Contact: ___ ._ . _ _..��_11... -----Title: _ . _ . _... Phone No:
Onsite Representative: �Q.,,�,�e=Zb Qb,. Integrator. _.. &UM -a ,.----.W__...____--
Certified Operator: _______ _ _.. ____. _ Operator Certification Number:
Location of Farm:
I-V
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude 46
- Cnrreat f
t _ I'
, .1.ilrrent : " Cnrrrent
Swme w ... q _ M.
:.._
`oio Catde z `
_ yPoultry�
_.Po
.-Po :-P+o an
Wean to Feeder Layer
Dairy
Feeder to Finish O 2.00Non-Layer I
I- Non -Dairy
F=
` Farrow to WeanOther
Farrow to Feeder
f
Farrow to Finish T F
otal Design tY}
��j
Gilts 2l-5
Boars -
= ;Tot$-;SSL�V
�LL,,,,,_.,,,,,
Discharges & Stream Im aCt5
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ N
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZNj
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1.
Freeboard (inches):
12112103 Continued

Facility Number: 3 — Z Date of Inspection ? Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes E!rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes [. Igo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or euvironmentaI threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �o
8. Does any part of the waste management system other than waste structures require maintenance/unprovement? ❑ Yes E No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
o
elevation markings? Yes
Waste Aoi3liration
10. Are there any buffers that need maintenancelimprovement? ❑Yes N
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding {❑�� PAN ❑ Hydraulic Overload [I Frozen Ground ❑ Copper and/or Zinc
UN
12. Crop type Ri�IA Ur \1 SG
r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNIP)? ❑ Yes WN
o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b)Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes a
15_ Does the receiving crop need improvement? [!Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes�Vo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge.at/or below ❑ yes U40
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 04-fo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Q40
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 l..J'`to
Air Quality representative immediately.
Fuse arawmgs;or �c�ucy w'ne�er aq�m s��aq�.�tase'aumz�a�'•p�ges as �'Y °� ❑Field Cop ❑Final Notes w
� 5.� C��T'r._.�J UE lnf E [..+� Cam►-�'CR.otl. , A.
ro O'> 1" t7' PLCO -t-ASPEC't'S.a�
'A)L coe-? b( SI.UD64_- suR.VE� C�1D) 351D - 200�i
r T
Reviewer/Inspector Name _ii 1';A2` -'� '�� _--� � emu .. � � a�z :�� _ ��. r
Reviewer/Inspector Signature: Date: 'i 2�t D
i!r/li/VJ yV�srrrarac�

Facility Number: 31 Date of Inspection 2g
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal"Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 7No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 24
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes [ zo
26. Fail to notify regional DWQ of emergency situations as required by General Permit? /
(ie/ discharge, freeboard problems, over application) ❑ Yes 21 of
27. Did Reviewer/Inspector fail to discuss reviewfmspection with on -site representative? ❑ Yes �P19
28. Does facility require a follow-up visit by same agency? ❑ Yes 29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) dYes ❑ N
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes7No,
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes34. Did the facility fail to calibrate waste application equipment? ❑ Y
Does record keeping for NPDES required forms need impro meat? If yes, check the appropriate box below. Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall spection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12/1V03

2
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: C
P Permitted O Certl£ed 0 Conditionally Certified [3 Registered
Farm Name: 14 r) M e m
Owner Name:
Mailing Address:
Facility Contact: nn Title:
Onsite Representative: (A. rJL�ZZ AR4�
Time:
Date Last Operated or Above Threshold: _
County VJtm:L =N
Phone No:
Phone No:
Integrator
Certified Operator: Operator Certification Number:
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` OK Longitude 0' 4 Du
Wean to Feeder
Feeder to Finish
L_I Layer
❑ Non-1
Farrow to Wean
❑ Other
Farrow to Feeder
Gilts
Subsurface Drains 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 gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes Pq No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes ;ffNo
❑ Yes P No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
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?
I I - Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type ,7�GLmmr2 Al J Vn17" I+ri \ OVlzp , Z:10q �6y
13. Do the receiving crops differ With those designated in the Certified Animal Waste Management Plan (CA
l4, 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?
❑ Yes No
❑ Yes VNo
❑ Yes V No
❑ Yes O No
❑ Yes IoNo
❑ Yes 0 No
❑ Yes V No
W J�F_aT
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ;Z No
❑ Yes P No
❑ Yes [:� No
❑ Yes O No
❑ Yes No
❑ Yes No
❑ Yes [6 No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
[/No
No
No
O No
VNo
No
No
ONo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
" x lain an YES answer and/orFanrrecontm gdeons Dram .utherrcoin of Comments refer to " d&tion x
,Usedrawtngs of7taciltty to betterealslain situatsons (use addrhonal_pagesasnecessary)s,, ❑Field Copv ❑Final Notes
3,
4� jc SuRC J U5 N:5-r� tjKeys s `one S-re_
SflmP� �u6T "1 �L Gp �oR �jPv--u �1�f�
r � t r 17
�Ll RC�I C P, LC 4k L f,-I'-z__0 N 5 C_,rRR-2_) 13t,16FCD Dry �OPY,-rFL
I)pit, eS 17rn 74©Z,
Reviewer/Inspector, Name
Reviewer/Inspector Signature: Date:
05103/01 Continued

• .—
Facility Number: —5 Date of Inspection
Odor Is- sues
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?
28. 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 permanenthemporary cover?
Additional Comments and/or Drawings m;: A . °V V;
_Z0-��
s�_C 7:;
❑ Yes V No
❑ Yes VNo
❑ Yes No
❑ Yes [;a No
❑ Yes J.—A No
❑ Yes ONo
❑ Yes ❑ No
O5103101

}
Type of Visit Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit 21koutine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Faciiiri- Number 3 1 Ct Date of Visit: 7-0 O Tune; Z I I
Not erationat Q Below Threshold
❑ Permitted 0 Certified 0 Conditionally Certified [3 Registered Date Last Oper-attend or Above Threshold:
Farm Name: �/ �'nn"�� 0. r'~`� County: L Ule 1r,,
�+``
Owner Name: 1�' ' 2_ ?—A Phone No:
Mailing Address:
Facility Contact: ^^ Title: Phone No:
Onsite Representative: Cl 13 1 t LZGI _ Integrator: Ptre
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 01 0" Longitude 0' 01 0�
Design . -Current ; . Design Eurren Design Current
Srrtne = : -Ca acitv�.. �Po station ` Poultry ....: Ca acrtr d=Population Cattle _ .Ca acttf =Po ulafton
ElWean to Feeder - ❑ Layer _ ❑ airy
❑ Feeder to Finish ❑Non -Layer ❑Non -Dairy
__ _ -.
Farrow to Weanw s
❑ Farrow to Feeder ❑ Other -
❑ Farrow to Finish Total Uestgn t3l.
❑ Gilts
❑ Boars Tots1;SSLW
1Vnmbetr of Lagoons ❑Subsurface Drains Present ❑ La oon Area ❑ S rav Fi Area
HoldtpPonds ! Sobd Tra s
.:.-.�_ " . �� ❑ No Liquid Waste Mana ement Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes Z'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑Yes ❑ No
b. If discharge is observed, did it reach Water of the State" (If yes, notify DWQ) ❑Yes ❑ No
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 7No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 'IE:fNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Freeboard (inches): 3
05103101 Continued

Facility Number. 3 f 51Y Date of Inspection 20 O
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/ trees, severe erosion,
❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure
❑ Yes No
plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes kNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ;2 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ ONO
elevation markings?.
Yes
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes [2rNo
11. is there evidence' of over application? Excessive Ponding ❑ PAN [I Hydraulic Overload
El Yes PNo
/❑
I2. Crop type C-0he WhC!Q 425,gkf eZf,-V rvlvg
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes IffNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
'7No
❑ Yes
c) This facility is pended for a wettable acre determination?
'p"No
❑ Yes �TNo
15. Does the receiving crop need improvement?
❑ Yes ,25'No
16. Is there a lack of adequate waste application equipment?
❑ Yes ZNo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes ONO
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes � 3 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ;; No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes P�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ONO
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes�No
24. Does facility require a follow-up visit by same agency?
❑ Yes ,E:rNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ZfNo
113 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
;Comments to questiost #) ` Exphtin airy YE5 answers ar#dior any rotmeAdateoas:tsr aiy:athe ciimmEeiits -
Use:drawibt!i of facility to:better eitplain s�Cations (uie aaddin6" pages;hs neressary)❑Field Copy ❑Final Notes
��e ��`;1►� y, ��-�s, irec,,,ds a,-e jvel j ker4 .
Reviewer/Inspector Name =
Reviewer/Inspector Signature: Date:
05103101 Continued

ti
Facility \umber: 31 —51Date of Inspection ZO4 Z
Odor Tssues
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?
2T Are there anv dead animals not disposed of properly within 24 hours? ❑ Yes P(\o
28. Is there any evidence of wind drift during land application" (Le. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e" broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged pill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments- and/or Drawings: T _"
05103101

_N'r Div1s16n-of Water Quality
Q;Division of Soil an&Water Conservation -
c = -
s bbilier Agency,
-
:;.
Type of Visit 21Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit eRoutine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Dale of Visit: S l i �l+ Titne: I-,L�—�-J Printed on: 7/21/2000
Facility Number 3
.__,_,, ,, _.. Q Not Operational Q Below Threshold
❑ Permitted 0 Certified ❑3 Conditionally Certified ❑ Registered
LdFarm Name: ......2.'.M !L?...TIin............................................................................
Owner Name: .......... -0.K..... k ..z.4al do..........
Facility Contact:
.................... Title:
MailingAddress:---.................................................................
Onsite Representative:.... Q � Z ZQ,
..............................................
Certified Operator:
Location of Farm:
Date Last Operated or Above Threshold: .........................
Cottntv:..E).. .l.-.h.........................
Phone No:
Phone No:
........................... Integrator:. rC. f Gt .........................................
.......... I.-............ Operator Certification Number.,... ........................
JJSwine ❑ Poultry ❑ Cattle []Horse Latitude • 4 '1 Longitude ' 6 69
Design Current
Cainackv. . Ponulation
Wean to Feeder
= Feeder to Finish
- Farrow to Wean
Farrow to Feeder
- Farrow to Finish
Gilts
Boars
Design Current Design : Cturrei4t
Poultry Capacity Population Cattle . --ci l Po ulati(in
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Noinber of Lagoons , ❑Subsurface Drains Present ❑ Lag�nn Area ❑ Spray Field Area
:Hotdmg Porn)s / Solid Traps ` No Liquid Waste Management System n
Discharees & Stream Lnpact5
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. ll' discharge is observed. what is the estimated flow in gal/ruin?
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
Stru-cure I Structure 2 Structure : Structure 4
Identifier:...................................................................
Freeboard (inches): �z
5100
❑ Yes ONO
❑ Yes Z'-No
❑ Yes )2 No
n l(A
❑ Yes LT'No
❑ YesZNo
❑ Yes No
❑ Yes,)EY'N-o
Structure 5 Structure 6
Continued on back

Facility Ni Thq: Date of inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
l
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/improvement?
❑ Yes kVqo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes INo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 'E�No
11. Is there evidence ofover application? ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
❑ Yes �No
12. Crop type Cot, ri j w heot4 .Sp��L SV inn Iyy4y- A�?n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes "E�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes "No
b) Does the facility need a wettable acre determination?
❑ Yes )two
c) This facility is pended for a wettable acre determination?
❑ Yes XNo
15. Does the receiving crop need improvement?
❑ Yes allo
16. Is there a lack of adequate waste application equipment?
❑ Yes VrNo
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes o
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 )dNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes �?No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes )3No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes Mo
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes /'--' No
24. Does facility require a follow-up visit by same agency? Cl Yes 32110
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ';�(No
:.1%.*i0iatigris:or deficiencies -were .n #- during 4his:v1sit: • Yo6 wiil•t e;p Wci ii6 further
cones deisce: ah6iA thvisit_:....... .... .
Go inietits YES refer to ues4b>a #} Explain°any answers and/or any recommendations or any other eammeats -
i 9
• I .L� �r .S V r� -�0 l%Se 4 tnV0L3 4e- ' l "L � � j S ids LLa � �. � � �' [ � e��'l f 'O *[ 3
a r GL► �iv h e vc q-o e � 44e �i�y Z / reG41�►�t �►�te.,Ld Zo -A fie
G1&'3 6 Sam, ever 6� a s -Fd 0 Lt1 fi -rs nl��o ¢n is
K�ir rSAM
l r
Reviewer/Inspector Name 'tOv] e! Wti 1 Wei.,
Reviewer/Inspector Signature: /+,%` w Date: d`' P 51O0

Facility -Number: -FJ Date of I nspection S / Q Printed on: 7/21 /2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [:]No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 116
No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes�INo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ YeslEfNo
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 !fqo
31- Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑INO
32. Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover? ❑ Yes Mo
Additional!omments`and/or Drawrngs:..
r71
5100

Division of Soil and Water-bb__ - rvation ,Operation Review ,
Division of Soil and Wte ar.Conservation ;Compliance Inspection y
PkDivision of Water Quality °Compliance Inspection
a� 0 Other Agency : Operaho€� Review = �: " . � �
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Date of Inspection (�--- -2--Op
Facility Number 3 t 59
Time of Inspection ; do 24 hr. (hh:mm)
Permitted [Cejrrttified 0 Conditionally Certified 13 Registered E3 Not O erational Date Last Operated:
Farm Name: T [m.g;....... rA.,I.M................... ... .. .. County:..........�.� .1 ..r�............................ Q .......
Owner Name:........./...: Z.d..kl. r PL............. ..... Phone No:...................................................��1Ss
{1....I....:............. .
Facility Contact: ..... .:. ........... 1. G, .................. Title:s..................................... Phone No:...................................................
Mailing Address: .......................
................................................................................................................................................................................... ..........................
Onsite Representative:......... L....................................... Integrator: �......................................................
G
Certified Operator: ......... b..... R... .... .��, l�, z a„v„ .............................................. Operator Certification Number:
Location of Farm:
.......................................................................................................................................................................................................................................................................... T
Latitude �' �° �•� Longitude
ian
Design Current - _ = = Design .` `Current Design Current
_Point _-Ca acity Po ulation rY ,Capacity . Population - = Gattle Capacity Population
eto Feeder
Ec Feeder to Finish
t� 1SO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Ni tuber of Lagoons . ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
~HolcLng`PondsY Solid Traps ❑ No Liquid Waste Management System
0� -..
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes r 0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. lC discharge is observed, was the conveyance man-made? ❑ Yes [ANo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [Vo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes qNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9LNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ....... . .......I.................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [ No
seepage, etc.)
3/23/99 Continued on back

L"'�UcilityLNumber -S 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 maintenatice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type /U &,f 0, ) ,
13. Do the receiving crop(d' fer Jh Vse designateS i0he ti
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?
ied Animal Waste Management Plan (CAWMP)?
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' �Vo yiolaiiogs"or deficiencies -were noted• di ifig ibis;visit: Yoir wit/ reeeiye Rio #'ui-ther
corresOonr)(eHee. about this visit. • • • . ........I.._......_.... • • • ' • . • . • -
6minents'(refek to question #) Explain any YES answers and/or any-recortrainendahons or any°other comtments
y ,
Use,drawings of facility Abetter explain.situahons (use additional=pages ais rnecessary) _
rr
4
❑ Yes 19No
❑ Yes RNo
❑ Yes ro
❑ Yes KNo
❑ Yes 9No
❑ Yes ULNo
❑ Yes Od No
❑ Yes [�LNo
❑ Yes [ No
❑ Yes j,10
Cl Yes t No
❑ Yes 4No
❑ Yes 0 No
❑ Yes jd No
❑ Yes C�No
❑ Yes W No
❑ Yes d(No
❑ Yes 30 No
❑ Yes kNo
❑ Yes WNo
Reviewer/Inspector Name
Reviewer/Inspector Signaturw---� Date.
3/23/99

,Facilt Number: 31 sff4 I Date of inspection 3-
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
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 k�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 KNo
X Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes RNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes R!o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional- Comments and/or Dirawmgs ::
AL
3/23/99

1 Division of Soil and Water`Conservation - Operation Review
ff
_ 1 Division of Soil and Wate 'Conservation -.Compliance Inspection
Divisi€oiE of Water all Qu ty--ConipLance Lispec4on x
Other Agency Operation- Review
10 Routine Q Complaint Q Follow-up of DWQ inssEection Q Follow-up of DSWC review Q Other
Facility Number S Date of Inspection
Time of Inspection S 24 hr. (hh:mm)
0 Permitted Iff Certified ❑ Conditionally Certified [3 Registered 10 Not Operational Date Last Operated:
FarmName: rl�.....�G.ir►'f'1................................................................... Caunh:...... .i� .....1..?....................................................
Owner Name: .............D4..9..._...! ..!..L..Z.'1.r` ...'•............................... PhoneNo:.��.�� �� �ZSQQ
.........................5%.....................
FacilityCoiitact:.............................................................................. Title:....................
MailingAddress: ...................q.................................................................................................. ..
Onsite Representative: ................................................... 1Z Z
4...............
CertifiedOperator: ................................................... .............................................................
Location of Farm:
Phone No:
... ..................�Yc...................................... .......... I...............
Integrator: ...................".l.S ..
Operator Certification Nu,Jlmber:...........
Latitude 0 & - Longitude • ' "
Design Current ". Design,, Current Design Current
Swine
Capacity Population -; Poultry Capacity Population Cattle Capacity Population .:.
❑ Wean to Feeder
®•Feeder to FinisL
5 Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Nuttuber of Lagoons: �- ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Holding Poii& % Solid'Traps ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9 No.
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
h. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes , ❑ No
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 19 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 24No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 14 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard(inches): ......- .d................................................. ........... .I......- ........................................ ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes g] No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ZJ No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ,1 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Anulication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
K No
1.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
H No
12.
Crop type C $ S �%
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
g 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
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Off No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel. WUP, checklists, design, maps, etc.)
❑ Yes
CK No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
JO Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gj No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
99 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
IgNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
X No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
19No
0: fl vi9latibris:ee deecieacies •were noted during �his.visit'. • Y:or Will r&0*16 Rio furtht!r
Cores onde' * * abut: this :visit.
ve r ..
Comments' (refer fo quest<an #) Explain any'YES answers and/or any recommendations -or any ,other comments: r
:Use drawings of facHity twhetter explain situations (use additional- ages as -necessary)
�=
ri. M.. 1 a�Catlh wa)ls, l>(ic,re SjP�t on
�i�j©OYi �..��i .5 ,
1q. New an 17's ne2Qe-d� IA.4 oWa( 3llglaq,
Reviewer/Inspector Named
Reviewer/InspectorSignature: , �..f�pt ) Date: Irl.51q9
3/23/99

Facility Number: 3 G Cate 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
10 No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
21 No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
,KNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
P6No
bona omments an or , raywngs;
3/23/99

0
13 Division of Soil and Water Conservation [j Other Agency
® Division of Water Quality
lof Routine` O Coin taint O Follow-ug of DWQ inspection O Follow-uE of DSWC review O Other
Date of Inspection M& ME
Facility Number
Time of Inspection © 24 hr. (hh:mm)
13 Registered 0 Certified 0 Applied for Permit [3 Permitted © Not Operational J1 Date Last Operated:
Farms Narne:........� ............ County � IkN .................... I ....... .......................
OwnerName:......................�..........................................................................-------... Phone No:...U.'pac....................-...........
FacilityContact: ..... ...........................................• -•--.-.I....------........... Title:................................................................ Phone No:...................................................
Mailing Address:....�.....`-_ ►'.1�..........G..3�............................ 11` t..�....C.......r......
............................-. Integrator:...Onsite Re resentative:./..!±-,. .1&....Q..........
3t{�..................
................
Certified Operator......................................................................-............-...-......-.........-.._.... Operator Certification Number, ...................
......................
t n of a
........... M1 `- f.... a a...... �^..... K...................................................` `3.............................aS.. '�........ 5..............
................
Latitude ���� ��� Longitude =• °
f Design Current
Design ,.'. ?Current : Design Curtest
Sine: Capacity Population. ^ Poultry
Capacity Population •Cattle .. n Capacity .Population ,
'
❑ Wean to Feeder
❑ Layer
10 Dairy
�
Feeder to Finish
$ 0
.
❑ Non -Layer
Non -Dairy
9
er
❑ Farrow to Wean
❑ Farrow to Feeder
ID Otherqm
w
Tofa Design Capacity r
-'
❑ Farrow to Finish
El Gilts
`#
❑ Boars
Total SSLW'
.
Number of I,agot as'f Holduig POn s ❑Subsurface Drains Present
❑Lagoon Area ❑Spray Field Area
:
1'
[] No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b- If -discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
f,
❑ Yes
VNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
O No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
O No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6- is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7• Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25197

i+
if Facility Number: 3 , --,lq
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding_Ponds. Flush Pits. etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier: .............. ................. ........... ..................
Freeboard (ft): .... ....... ......,................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
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 G1.1h? rti ...... u`"` !� i �S �F------------------•...........----.............................................................
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?
0 No.vialations or. deficiencies: were noted iiuring this'visit.- You.wtill receive n0 ftirther
eofresOfideinced oufthis:visit::
❑ Yes 9No
❑ Yes t!�No
Structure 6
❑ Yes C�No
%Yes ❑ No
0 Yes ❑ No
❑ Yes ONo
❑ Yes 1A No
❑ Yes N No
❑ Yes toNo
❑ Yes allo
❑ Yes ONo
❑ Yes ONo
❑ Yes ONo
❑ Yes ❑ No
❑ Yes [ No
❑ Yes No
❑ Yes ONo
X,{8+^#mb^�D]D R.d"'.2Fnd" •offr'H�' �x h .E' 3�•+ S`'ri 'Ei" cy7y�+i�x- �2, 9{' e. i3�, � -`6 ,ksr,�
, Comm�#s (re�fec,queshon #}fxplarn an}� YF.S answers andior any reeoanmend�abons orka3tty�tiEher ct►m�pner►is.
-
e Lira s of fata yFtQ°better explarn s►taaat s. {usc addr€tan$l pages as seGcssarY} r e 3 k
a. ,..-PlY�t'��F
tt��` __£,i,:r ff[[,.�'�A-"�,
f �G W \Iw4� , L14\ + , G�►^es� Qom. `C1� wit%�,'y
G�
7/25/97
r
Reviewer/Inspector Name 'f�E°
to
M r _...M ... K
Reviewer/Inspector Signature: Date: �a 3o mil$

-- ----
_ DSWC Animal Feedlot Operation Review :� F
A w ® DWQ Animal Feedlot Operation Site Inspection
Q Routiue O Cum faint O Follow-u of DW ins action O Follow-up of DSWC review O Other
Date of InspectionE1 L
Facility Number Time of inspection 11 5 0 24 hr. (hh:mm)
Registered UCertified [3 Applied for Permit E3 Permitted JE3 Not O erational I Date Last Operated: .
Y ip
Farm Name:.............Y'.�.......T�.O.xw1................................................... I............. COuntv:.....
.r1..11.1A.l..Y-.................................i�1�.�..i:.. i
O4-ner Name:........ ..-... .............................. .i..1..2..Zs . �..... .r..,................... Phone No: ... �.°�..1..i0 1y.. .°1..�...`..1 i�... ....................
Facility Contact: ... Title: ... Phone No:
........................................................................................................................................................
Mailing Address: .....I...�..50.. ....... ..C.t.. 1.5.... ......1..4. ..... .-. ... .. tr S�?.!.......Q.C.......................... ..�.g............. ... ..... .. y
Onsite Representative:. .. ....----.... .!.. _ ............................................ grator:....� '. .S..f a .i ,........................- .
into
Certified Operator................................................................................................................ Operator Certification Number s........... 117.>q........
..
Location of Farm:
t?.�.....5 a., .....s .i q.... , ....g.......,ra. .!.., �...... D -. 5......► + .►. .....e u .,t.... .. •
p..e. io..u�.....w.� ..... .. 1.r..r..�...�..-.................................................................................................................................................................................
Latitude Longitude
Design Current Design Current Design 'Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity ,.Population Cattle Capacity; Population
❑ Layer 10 Dairy
❑ Non -Layer I I j[__1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
.......................
Nu. mber of Lagoons I Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
❑ No Liquid Waste Management. System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in al/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?
7/25/97
RYes ❑ No
❑ Yes C'No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes 0 No
❑ Yes l;� No
❑ Yes O-NO
Continued on back

Facility Number
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes E[ No
Structures (Lag6ons,tfoldlniz Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft): ........... Zr ................. .................................... ................................... .................................... ....................................
.....................................
10. Is seepage observed from any of the structures?
El Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed)
Z�
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 WVIP, or runoff entering waters of the State, notify DWQ)
15. Crop type .........I ............ ..................... .1.............................. ...........................................................................................
.........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
R1 No
17, Does the facility have a lack of adequate acreage for land application!
❑ Yes
91 No
18. Does the receiving crop need improvement?
El Yes
No
19. Is there a lack of available waste application equipment?
E] Yes
No
20. Does facility require a follow-up visit by same agency?
[3 Yes
0 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
[9 No
22. Does record keeping need improvement'?
0 Yes
El No
For Certified or Permitted FacilitiLs Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
0 Yes
0 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
B No
25. Were any additional problems noted which cause noncompliance of the Permit?
El Yes
Q No
0, Nwviola'tio'ns or'de'6cienkie's were-no'te'd-du'rin9 this- visit. -.Yo'u "W'ill receive no ftirther".
coeresOfiden & about this'visit.,'-
CSiiuiiierts [infer to'q'qiestiion #):4:kpIain. any-YES,answers and/or -t. - . amefitsiiA - Kc 1Z.:
yfreconam�n .6a ions or.any::,otfier co
dr-;5'W'Ali f iadlitv to betterexp ainsituatibns. (use additional qnal pages Ps:necessary}
Sr-a-jeyj tin r 07F; A'lr C L-e, to V
15,k,_ Y-" t o-� is o A- e,�
A 1 evt vi a-L ,1 .1 0-, 1 P o:,v Wa
W 1 4-
V� q km '0 e- S, 1, -a t P_
q--V C--i r--f- O 4; 0 V-_.
t��LL- brL V vl^ k-ft-,IL U I 4X CO c-,c t, F, r 0 W 'I t-tA J, t.)4
Y% %110 +-v-*-q 4,
EL QO-A to oy�
1 4^�
t>*J, c V" I t," 7/25/97
� - -4. "" , tZ, H,
I Reviewer/Inspector Name
I Reviewertinspector Signature:
Date:

Site Requires Immediate Attention: /Lb
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION VISITATION RECORD
• DATE: 7):rl995
Time:
Farm Name/Owner: _ ale
Mailing Address: /
County:
Integrator. Phone:
On Site Representative: Phone:
PhysicalAddress/Location:
Type of Operation: - Swine V/ Poultry Cattle
Design Capacity: g4M % 6,P Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3� ° ' �" Longitude: - 06 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Ye or No Actual Freeboar `4.�Ft. ( Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for ay? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No'
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spec acreage with co r crop)? es or No
Additional Comments: LL �Pi Cr t7
Inspector Name Si ature
cc: Facility Assessment Unit Use Attachments if Needed.