310679_INSPECTIONS_20171231

NORTH CAROLINA
J
Department of Environmental Qual

(Type of Visit: Q CpAi'Pliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emereencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: I I r)y Departure Time: R r County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: !Title:
Onsite Representative: O� i`,C� [r
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone:
Integrator:
Region:
Certification Number: 2.-4rpS—
Certification Number:
Location of Farm: Latitude: Longitude:
Design Curren# Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
iyf an to Finish La er I
Design Current
C►at#le Capacity Pop.
Dairy Cow
Wean to Feeder c{o Q
ULA QQ
I INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Dryinquitr; Ca a_ ci. P,o
Layers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non-Dai
Beef Stocker
Gilts
Non -Lye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther Turke Poults
Other 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
[]Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes F1 No ❑ NA ❑ NE
Page I of 3 21412015 Continued

421
Facili' Number; 1- Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to "_o ❑ 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: 2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� 3 d
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 7No
^ 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 ❑ 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 thr t, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No Q 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 Aanlication
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
❑ E ssive 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
ff No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
LJ 00 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 0NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes2-No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Judge 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
0
❑ NE
Page 2 of 3
21412015 Continued

f
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �NoEo]
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludgd survey El 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 0_<0 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No D<A ❑ 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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the 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 fo Q NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Comments (refer•to question ft Explain, any, YES°answers and/or aniy;additional. recommendations,or any::other:comments "
Use drawings'of facility to better explainsiteiaHons (use additional pages•as necessary):
r< /'lit, O fi bn A
5$r�re Per. '� �� !' l 1' k
a wOT
l� sn
�o f k r,� a n f o b r4�sp� S 4P A--- 69c,- en fe-S E' t
L't �- t Pf Al ► 5 2 r,0 Its .
.� c �• n , cal S P �c a If S� r. c
D v M , 4--,e 4, Ili` K,
15 w, 41, o 4 (, sg.l .4,1_ i—s- 4c,—; �-LA r,,.rok n K, .
Reviewer/Inspector Name: IV a , ( j Cc) `-e- (f
Reviewer/Inspector Signature: ` e'_ -A
Page 3 of 3
Phone: 0 7 7G 730 y
Date: / 3 1 6r
21412015

Type of Visit: U Co pliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance V
Reason for Visit: q itoutine O Complaint O Follow-up O Referral O Emergency O Other O Deni d Access
Date of Visit: *01 Arrival Time: Departure Time., County. Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: V cu'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop,
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
C+attle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
D , Houltr,
Layers
Non -Layers
Design
Ca aci
Current
Po _.
D Cow
Non -Dairy
113eef Stocker
113eef Feeder
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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 FN
[DNA ❑ NE
❑ Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page l of 3
21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E No 0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (� �L'�j} ,
Spillway?:
Designed Freeboard (in):
00
Observed Freeboard (in): 4V'b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 6No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ 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 environmetytal 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 �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 [INo
❑ 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 [2/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�es ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes YNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [2 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 214
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility- Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E2 N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ 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 L64/()
<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?] Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [�o ❑ NA ❑ NE
❑ Yes 12No ❑ NA
[] Yes No ❑ NA
❑ Yes dNo ❑ NA
❑ Yes ❑ NA
❑ YesrNo
[] NA
❑ Yes ❑ NA
Comments (refer to,question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility, to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatus
Page 3 of 3
Date:
rs
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE

(Type of Visit: U'CO pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ®Q Departure Time: lh=County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: kett N Ljus Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Certification Number: 900al
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pap.
Wean to Finish I
Design Current
Wet Poultry Capacity Pop.
La er]Dairy
Design Current
Cattle Capacity Pop.
Cow
X
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Design Current
D . Plouitr, Ca aci. P,o ,
Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Da*
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
TurkeX Poults
10ther
Discharges and Stream Impacts
/1110
I . Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�Zo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number; _ Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: {, [ A&oQ4 Z,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�!
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I 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 [:2�o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EXINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,'setbacks, or compliance alternatives that need ❑ Yes ErNo [] NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect nd application? If yes, check the appropriate box below.'es ❑ No ❑ NA ❑ NE
❑ Excessive Pondir 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
Ifj No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
YN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FN
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 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 k
❑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

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes UNo ❑ 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 [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ Nvo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
0 Yes �No
❑ Yes U�No
❑ Yes dN0
❑ Yes En No
❑ Yes ]� o
❑ Yes [�o
❑ Yes No
❑NA ❑NE
[] NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
E]NA ❑NE
Comments (refer to question Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Qu S11III 5 jujr4 40119111s 0 a_ I&I 1 aC&r, C-All
PP �T. �� C�I�ASS c � caN�rrsotJ , �p 04— ALLo\J
Reviewer/Inspector Name: Aiz dL�
Reviewer/Inspector Signature:
Page 3 of 3
Phone: II a p
Date: b 1 )
21412015

I
Type of Visit: Q plianee Inspection O Operation Review Q Structure Evaluation O Technical Assistance ' V
Reason for Visit: Co{Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 5 y"? Arrival Time: 3 d Departure Time: !b County: t>j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: W r-y mx Integrator:
Certification Number: 160 "I
Phone:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Currentall
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La er Dai Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr.. P,onitr.. C•_a aci P,o P.
Layers
airy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
3'urke s
Turke Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
d
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 the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: nil - Date of Inspection: 51,1,1 jig
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t�-oy &A (i &w*j CxbWU
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ` �J
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 E? 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 WNo
�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Z/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ]Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dWNo
o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes Er.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 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ 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. ER/yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections [%Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:3/No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 6/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Ficility Number: - Date of Inspection: y 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo ❑ 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 E3"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes (2rNo ❑ 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?
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 L2fNo ❑ NA ❑ NE
❑ Yes []Ko ❑ NA ❑ NE
[—]Yes ETNo ❑ NA ❑ NE
❑ Yes dNo
[:]Yes a�4o
[:]Yes [(No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
(} Up CAtE 5W a G SVR�IE v ND Cq t.8
JAMPLf= 10+01 aNn Lr_M. Nab(_-_9
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ?lb ) %
Date: ` a 1
214/2011

(Type of Visit: 0 Co�ipliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 151��11�. I Arrival Time: Departure Time:® County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ZAaaJ CVAMJ Integrator:
Phone:
Certified Operator: Certification Number:y0X I �^
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design C*urrent
Wet Poultry Capacity Pop. Cattle
Layer Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
tj0
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
D P,oul C•_a aci P,o Non -Dairy
ILayers Beef Stocker
Non-Laye Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes 2 No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
❑ Yes �No
❑ Yes o
[] Yes yNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: SI-7113
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4A&vc*J F CA 13
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3a 'La
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 dNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 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 WNo ❑ 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 VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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 0 Design ❑ Maps ❑ Lease Agreements
❑ Yes Q No ❑ NA ❑ NE
Vyes ❑ No [DNA ❑ NE
[:]Yes �/No ❑ NA ❑ NE
[:]Yes 12� o
[—]Yes [No
❑Yes WNo
o
❑ Yes
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [3Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [;4 N
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA [3 NE
2Weather Code
Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 31 - Date of Inspection. Vo)l 13
i
24. Did the facility fail to calibrate waste application equipment as required by the permit? Rryes ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �J/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E2<o ❑ NA ❑ NE
❑ Yes Ld''qo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes C? No ❑ NA ❑ NE
Yes
[� No ❑ NA ❑ NE
Ryo❑ NA ❑ NE
Yes
[o ❑ NA ❑ NE
❑
❑ Yes
❑
Comments (refer to question #):Explain any YES answers and/or any additional recommendations. or-.anyother comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
y.) LIME NECOQ0 o,J Fxe�l.n ' s npus
EY-0'A¢TLo►J lETtElL- CODE-U DEC.. 1L01'L•, OEVh To MAJE 0011X '6O CABS,
CAL mAAT=.,jJ NEE DcJ W=Tgz%A 3o i�AqS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 4 Ql l 4 6 —139 a
Date:
2/4 011

(01)fi
(Type of Visit: Q Co liance Inspection U Operation Review Q Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i3 i L Arrival Time: Departure Time: 3 $-, County: DUP Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: l3 A R2✓, +mil/ A ICJ S Integrator:
Certified Operator:
Phone:
Certification Number: 1,6 07-1
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
JP7SWine!
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Cattle
Dai Cow
Design
Capacity
Current
Pop.
4Da 1
Non -La erDa'
Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dr. P,ouIt .
Design
Ca aci
Current
P,o
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes % No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes [:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes [�] N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes L-J No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: l - Date of Ins action: 1 t2_
Waste Collection & Treatment
4. I4storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: U(d� '_) [��4__
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z�
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 I 4 ❑ NA ❑ NE
waste management or closure plan? 777"""
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 F3/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [-]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
N
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesEI'N/o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ej No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EJN/o❑
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
,
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes a-14'
"`" ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 V4/2011 Continued

Facility Number: 31- Date of Ins ectioa: {�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. '& the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes E/No ❑ NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑
❑ 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/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
[3/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
to
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
04400
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�jTo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional-recommendationsaor any other.comments.
Use drawings of facilitv to better exsflain situations (use additional oases as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Lybf;I� VA6Z0E%
Phone:IC lb
Date: I L.
21412011

F, ac>�>Ity Numbeir'
la
ivision of Water Quality .
vision of Soil an&Water.'Con
+ n •,F
ther'Agency
Type of Visit Co Hance 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 [I Denied Access
Date of Visit: 5 3 Arrival Time: © Departure Time: County: DU Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: // Title: Phone No:
Onsite Representative: i r�i t_l C1� �5 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ` 0 " Longitude:
De
'wine Cal
] Wean to Finish .
Wean to Feeder
] Feeder to Finish
] Farrow to Wean
] Farrow to Feeder
] Farrow to Finish
] Gilts
] Boars
Current 1
%'YopuFation Wet Poultry C
av
`" `"Current. _ -
5 Populagon;,�.F�Cattle.,.��
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
Turkey Pou Its
t❑
O Other
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood 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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: A6=�Wj_ I lA 666i L
❑ Yes, /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): fX
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNVNo
[I NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes ❑ 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 environmenta2Nj
eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
El NA El 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 No ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 21 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ 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
V❑ o ❑NA El NE
[o ❑ NA ❑ NE
FN
ElNA ElNE
ElNA ❑ NE
❑ NA ❑ NE
.Comments:(refer to question#). `Explain:°any Y&lES answers inr any:recommendations or, an} other comments " ,
Use drawings,of.facility to -better explain situations-. (use additional pages,as necessary):�_ h ,} , n
„..a'w'-►a:...a:'ai
Reviewer/inspector Name b (r,�,(%; phone: — 3
Reviewer/Inspector Signature: Date: '9-3 1
.rage z of J

} Facility Number: 31 Date of Inspection t
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes E3 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement?.If yes, check the appropriate box below.
❑ Yes
o ❑ 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?
El
NNo El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,�,
[3No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ej No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LyNO ❑ NA
///
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
NWOU
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C7rNo ❑ 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
Flo ❑ 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
o ❑i -NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Addit bnal Comments and/or Drawings:
Page 3 of 3 12128104

3l M. (115)
Type of Visit CCO "pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ( Koutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ION ko- I Arrival Time: Z3 O Departure Time: County: DI.D .-l) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Q>NCLE' CyNIX Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certifieation Number:
Latitude: 0 0 0 I= Longitude: [� o= s=
Design Current
�UesignCurrent
Design Current
Swine
Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ can to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
(off %4eon
r
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
El Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑Turke Points
❑ 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?
Page I of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
[I NE
❑Yes
Yes
VN..
❑NA
❑NE
❑ Yes
!d No
❑ NA
❑ NE
12128104 Continued

,1
Facility Number: Date of Inspection
Waste Collection & Treatment
',4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: �(�� _LPv-,c,,z,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ads a co
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
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 of improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes _U/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 _P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes QNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PIN o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
S:rVo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ir
❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
rNo
CJ
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations orany joit h e r'7 comments:
Use drawings of facility to better explain situations. (use additional pages-as.necessary):
Reviewer/Inspector Name �jp Phone
Reviewer/Inspector Signature: Date: 'HI,
P 2 3 I2/28/04 Continued
age of

a
Facility Number: —
Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ZN
ElNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
El NA
El NE
the appropriate box. ❑ WUP [:3 Checklists ❑ Design El Maps ❑Other
lNo
21. Does record keeping need improvement? If es check the appropriate box below.
P g P Y�
❑ Yes
E2
❑ 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 Inspectionss,�(]
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1,1Vo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Noo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,I.J�,
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PIN
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
1 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
o
❑ NA
El NE
Other Issues
/!!///
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
LET No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L 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
Q�
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LI No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number 3i (,'� 9 Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit V Routine O Complaint Q Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: y Q Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: f3A2iLY EvAOS Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [_—] o =] ' [_—] Longitude: [= ° = 6
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
Wean to Feeder
(,00
O O v
10 Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultx3 ❑ Dry Cow
El Layers
❑ Non -Layers
El Pullets
❑ Turke s
ElNon-Dairy
El Farrow to Finish
❑ Beef Stocker
❑ Beef Feeder
❑Beef Brood Co
dumber of Structures:
❑ Gilts
El Boars
Other
❑Turke Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes r No ❑ NA ❑ NE
El Yes
El No El NA
El NE
❑Yes
[I No ❑NA
❑NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
� ❑ NA
❑ NE
❑ Yes
Zo ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 31 — (o Date of Inspection I HI4/di I
Waste Collection & Treatment �f
4 I�orage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �/ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6obtJ 1 _ 6=1 7—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0 r�3 (
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes u 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 VNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 91 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 6 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 [4No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
1 L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
WNNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
DrNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
6No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L' I No
❑ NA
❑ NE
Comments (refer to.question4) Explain an} YES answers and/or any recommendations or.any ather�cotnments
Usedrawrngs of facility to better explain situaio tns (use addittottal pages as necessary) , 4
Reviewer/Inspector Name 6 1 Phone: ?ih 7 6 —73Ff
Reviewer/Inspector Signature: UA. Date: 6
D....., 7 ,.!' 2 17/7R/OQ !'nstfi�rr.nd
_ _ _.1

Facility Number: Date of Inspection L,4 64
3
Rgguired Records & Documents ,�(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElIJ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IJ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L✓J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2(No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ 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
YNo
❑ 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
eNo
❑ 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 P No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes b/No ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

qO Division of Water Quality
It =Facifityumber ,� �'� 0 Division of Soil and Water Conservation
- - 0 Other Agency
Type of Visit 6
�Coompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assi=Access
Reason for Visit 0O Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Den
Date of Visit: `1 p Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: eatr,,f iM-s r"e- LL Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = I " Longitude: ❑ ° = 1 = fl
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
[og6o I qft 1 ❑ Non -Layer
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?
Cattle
Design Current
Capacity Population.
❑ 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?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
❑Z
El NE
El Yes
ElYes
El
L�XNo
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number:5L-IfIV
Date of Inspection LYWOT
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I (.A 6V*1J L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0-113
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 LQ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Cl/No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tt�eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �]No ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LJ"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 L ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste ADDliCation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Ycs D4 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect
application? If yes, check the appropriate box below. E Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ET -Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ 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?
El Yes
,�f
LJ
ElNA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
r
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑Yes
C o
El NA
El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
LJ No
❑ NA
❑ 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):
Ilj I AQd dn�r_ fut! a/- �7dreul:L ovedar-W+ ellewp4d 20 kA.,'U 5 ►ksk#Id W
r/Jv� l g6m,Y7. C'n r✓aT Jlor'ce4b' q6 &"/�'h/ an Ake fu ll. �%Yy S!/,syrrlCl Also,
Phu. c J!1
6-0 WaJ V e-eA A4,040fG w
Reviewer/Inspector Name arYN Phone: % 9 - 3rf
Reviewer/Inspector Signature: Date: 8
12128104 Continued

t
Facility Number: ?j — b Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LI No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EK: ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El b ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? �Iycs
es r ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El No ❑ N ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No A ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E3<o ❑ 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? ❑ No
Yes D ❑ 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 ONo ❑ 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 UrN10 ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional 'Comdtents:and/or Drawings .'W-
Page 3 of 3 12128104

Division of Water Quality
LaciLlityumber 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit Ck�o��mpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit () Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit. r Arrival Time: i'L 3 b Departure Time: County: .��V��L N Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
ZLL=e
Onsite Representative: E%j A)JS )4�"N _
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [= c = 6 Longitude: = ° = i = 4i
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
® Wean to Feeder LLEOQsa o 0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non-Layet
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ 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 E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
L.
❑ NA
ElNE
❑ Yes
No
❑ Yes
�❑
L7
El NA
El NE
El Yes
LJNo
[]NA❑NE
12128104 Continued

Date of Inspection o
Facility Number: 31 — G7q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo ❑ 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: [ A (�cpA, 1 114 &c3poJ Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -3U 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElLd 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
EfNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
D 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
EdNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z� No ❑ NA ❑ NE
ma intenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1Q% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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
eNo
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
E)'fNlo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination?❑ Yes
[3No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
,O�
LJ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
)A) S
1W
Reviewer/Inspector Name o p Phone: D — 3
Reviewer/Inspector Signature: Date: S
y�inn ins r_ _1
ALfbuf UY { UrL­*"C"

Facility Number: Date of Inspection S o
I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0"No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other ��,.,._.,1 Y,,��
21. Does record keeping need improvement? If yes, check the appropriate box below. Les ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
ElNA
ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E No-
[I NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L1'1Vo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
B NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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?
El Yes
,��,,//
L7 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
ElL7 Yes
��
No
❑ NA
❑ NE
General Permit? (ief discharge, freeboard problems, over application)
,��,��
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
L� No
ElNA
[INE
33. Does facility require a follow-up visit by same agency?
Ela Yes
o
❑ NA
❑ NE
Comments and/or Drawings:
12128104

V Division of Water. Quality
Facility Number 0 Division of Soil and Water Conservation
-- 0`Other Agency
Type of Visit of Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: ® Departure Time: County: A?LeldRegion:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: k('ZA FyAtjs.., _ _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 = it Longitude: = 0 0 A =
` Design Currents Design.-.-' Current. ; Design ICU
:Swine" Capacity PoptEiation Wet Poultry Capacity Population Cattle Capacity Popu
❑ We to Finish
10 Layer
—
® Wean to Feeder
p
❑ Non -Layer
❑ Feeder to Finish—
v:
❑ Farrow to Wean
i Dry. Poultry
❑ Farrow to Feeder
❑ Layers
❑ Farrow to Finish
❑ cilts
❑ Boars
s Other
ElOther
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
❑ Dairy Cow
I
❑ Dairy Calf
❑ Da4y Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Nhmber'cf Structures
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes ZNo ❑ NA ❑ NE
El Yes
El No El NA
❑NE
❑ Yes
❑ No ❑ NA
❑ NE
No El NA
❑ NE
❑ Yes
El Yes
„❑
C! N ElNA
❑ NE
❑ Yes
IJ No ❑ NA
❑ NE
12128104 Continued

fIFacibly Number: Date of inspection
�r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 4W tJ l LAC-zs&h! Z
Spillway?:
Designed Freeboard (in): 11 "s , S
Observed Freeboard (in): X'?
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EfNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E 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 th t, 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 2 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 El3 Yes o ❑ 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 ❑ 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) cp_NTr$o(� Soo r� E_&i'KUZA S"D ,S�(r0 oh -Ts
13. Soil type(s) kna,,?& L L-4 1l�tE`-� �51r-(,-Sto� �
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,Gr/NNo ❑ NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes Id No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
[;/No ❑ NA ❑ NE
❑NA El NE
No ❑ NA ❑ 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):
2 [�) ►/660nb s urmu r_A Lt-3FAu 4kD UPoarr" r ec D K0O.
Reviewer/Inspector Name I _ '. 'eOA O Phone: (ib) %j(o" 7 ;L-6 5-
Reviewer/Inspector Signature: Date: V 1313 j6(o
Page 2 of 5 121-76104 ConUnued

Facility Number: — 'j Date of inspection 3 ►y
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 E3/No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other --,
21. Does record keeping need improvement? If yes, check the appropriate box below. QlYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Wee ly Freeboard El Waste Analysis ❑ Soil Ilysis ❑ Waste Transfers El Annual Certification
❑ Rainfall ❑ Stocking Crop Yield El120 Minute Inspections Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Id No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
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?
❑ Yes
❑ No
ZINA
❑ NE
❑ Yes
❑ No
�NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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?
Additional Comments and/or Drawings:
❑ Yes
EJ No
❑ NA
❑ NE
❑ Yes
IJ No
❑ NA
❑ NE
❑ Yes
B No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
T'No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ounty: v�,^j Region:
Farm Name:�r K E
j6a n5 _ /✓[i Owner Email:
Owner Name: 2T/ / r —LI 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: , I �Title: qj
Phone No:
Onsite Representative:�Integrator:
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
Operator Certification Number:
Back-up Certification Number:
❑ Q [=. N h = 0 =4 ❑ [I
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Other
❑ Other -- --
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
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)?
Number of Structures: lil
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 FfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection l0 D
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 Stn}cr e 2 Structure 3 Structure 4
Identifier: i
Spillway?: d Q49
Designed Freeboard (in): 7,s
Observed Freeboard (in): a Z
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 ;� No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 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 [A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
1 L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
01
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑
yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
it A15 8 fi
lie
Reviewer/Ins ector Name ' r
P Phone: 0 �!
Reviewer/Inspector Signature: Date: (13
l2128104 Continued

Faccilil
ity Number: — Date of Inspection i4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes V(No ❑ NA ❑ NE
the appropirate box. ❑ wup ❑ Checklists ❑ ❑ Maps
Design
g p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
9Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
zi Rainfall ❑ Stocking Ef.Crop Yield )Z 120 Minute Inspections 9fMonthly and 1 °
Rain Inspections 0
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PrNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VrNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PfNA
❑ NE
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
V(No
❑ NA
❑ NE
❑ Yes
PfNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
XNo
El NA
El NE
El Yes
� No
❑ NA
❑ NE
❑ Yes
Uf No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12178104

(Type of Visit J6Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit QlRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 6 7 Date of Visit:
Permitted 0 Certrfieed E3 Conditionally Certified 0 Registered
Farm Name: ...4 L .. —ar.l........__._._........_....................... --
Owner Name:(I t�l a!��.............. .w .... _........
MailingAddress: ................. -••...................................................... ..........................._...._
Time:
Date Last Operated or Above Threshold: .................. ...
County: 1...... ............
W ... _ ... .
PhoneNo: .............__................ ..... ..._ .... ....... ..... ...... .........
Facility Contact: .. _._. _. _..._............... Title: Phone No:
Onsite Representative:rt.GCCI,F�.'��..lfi1/.[1atlG�. ................. Integrator•.f,61..C.F...........................................
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 06 0" Longitude • C 44
,Design
Current Design CurrentsT gn Al Cur' rre"nt
SWme Ca -ac3 AT
v -�
Mahon Poultry „,� Ca""Po ulat'roti:. Cattle Ca aca ., fPo i>ZlatEan
Wean to Feeder
Dairy
i°
Feeder to Finish
F ❑ Non -Layer 1 f4 ❑ Non -Dairy -
Other
Farrow to Wean
❑ Farrow to Feeder
.._-:
° T©W Des n Capaclfty
Farrow to Finish
Gilts
T©tal SSLW.'-�
❑Boars
,� � Nninb s of Lagoons '.
Discbaraes & 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 gaVrnin?
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: _.. ............. W _ .. _.............. ---------
Freeboard (inches):
12112103
❑ Yes ,�0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 2<o
❑ Yes z1Z
❑ Yes ;dNo
Structure 6
Continued

Facility Number:.3 - 67 q Date of Inspection
` 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/�trees, severe erosion,
❑ Yes
o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
2rNo
closure plan?
(If any of questions 4-6 was answered yes, and the situations poses an
immediate public health or environmental 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 maintenancefimprovement?
❑ Yes
0No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
ZNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
j rNo
11. Is there evidence of over application? If yes, check the appropriate box below.
XYes
4&o
❑ Excessive Ponding PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copp r and/or Zinc
01
12. Crop type A'IZAW19.4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (C
)? Ptes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
9No
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
WINO
16. Is there a lack of adequate waste application equipment?
❑ Yes
R(No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 00
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �To
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes�No
Air Quality representative immediately.
Field Copy ❑ Final Notes
l3) 1 4�5 �t-�4ra?�� i.> �%Eia05 /2/cJZ.�/1�T
GUGfP GzsT S_O
Reviewer/Inspector Name
ReviewerAkspector Signature:
Date:
12112103 Continued

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

Ll
of Visit OCompfiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Fallow up O Emergency Notification O Other L7 Denied Access
Facility Number Date of Visit: %� Time:.. l !Gym
10 Not Operational O Below Threshold
13 Permitted [3 Certified fl Conditionally CertWed [3 Registered
Farm Name: .. ..._...Flf]LirS.......!!...:................. ..............
Owner Name: ?�•GZ�Q ,U/ i �1 l�f d5
Mailing Address:
Date Last Operated or Above Threshold: _................. ..._.
G ~'
Count}:..... --...�. ��............ .........
Phone No:
Facility Contact: .... Title: ................................................................
itle:................................................................ Phone No:...................................................
..........................................................................
O>asi#e Representative: , l`17........'!z..f ... ( Integrator: �� p��
f..................................__........................................................ .....
CertifiedOperator •............. .......................................... I .......... I ....... Operator Certification Number:....,,...................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 Longitude • 4 66
Wean to Feeder
Feeder to Finish
'.' ❑ Layer
„ ❑ Non-L
Farrow to Wean
<' ❑ Other
Farrow to Feeder
Farrow to Finish
:.:...
Boars
Subsurface Drains Present
No Liquid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at O Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
Non -Dairy
Lagoon Area jp Spray Field Area
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes (�No
3. Were there any. adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )?fNo
StruFture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: --- ..... .j.��.jZ._QQ]._.......... ......�.,.zt... .---•......................... ............ ........ ... ...... •.......... ....... ....... ......
_ .... - ....... - - _ .
Freeboard (inches): ...........L.a.,-,- 2-6
c. If discharge is observed, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there` evidence of past discharge from any part of the operation?

Facility Number. Date of Inspection D?�.
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/�trees, severe erosion,
seepage, etc.)
6_ Are there muctures on -site which are not properly addressed and/or managers through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses art
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 maintenancelimprovement?
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 maintenanc-Mimprovement?
❑ Yes /No
❑ Yes /No
❑ Yes Z No
❑ Yes �No
Yes �No
El Yes ko
11. Is there evidence of over applica 'on? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload❑ Yes No
12. Crop type le JD �G Jd� �� ��'f}Z�►I �OV'CA f,
13. Do the receiving crops differ with those designated in the tei#ified Animal Wante Management Plan (CAWMP)? [i Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? Yes No
c) This facility is pended for a wettable acre determination?] Yes VNo
15. Does the receiving crop need improvement? © Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? [I Yes YNo'
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) El Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes A No
21. Did the facility fail to have a actively certifed operator in charge? ❑ YesNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit? //
(iet discharge, freeboard problems, over application) [� Yes No
23. Did ReviewerAnspector fail to discuss reviewtmspection with on -site representative? ❑ Yes Y
No
.24. Does facility require a follow-up visit by same agency? Yes X'o
2S. Were any additional problems noted which cause noncompliance of the Certified AWMP? . [{ Yes VNo
j] No violations or deficiencies were.noted.during this visit. You will receive no further correspondence about this visit.
�,.:.
.:a..a.::.:':-..}..:xa: .a..,:.:,.. :�'.•�-.. •----- ..,.:
.........:. : ,,...... ............v._ :. ..... .u. �-� • ,.,, •.iYa:i2::Y:L::`:'it}}s'`` i'xti.` **t:L;v^
.--.-:•-Fiel
FinalNo
d
......:.......:,. .:.: ...--�- - PY tes
..{ • .:L.. .:--..x.-:.-::;:ry ::.'![:y ,:,t::IXMY{�!U<c _�GiS'V:"�;'-=Ki7i]R} k4?ib::.:s.:
Aitluf�� /� sr, �cR lrftJ
Am, W�n�o�JS
.. v .
L{:r:. .C. - `:•.L:L-:i�?:N.•:�:^:i4::- __ _ :.1^h- - :M:t': "::'G::-:.:. :J':LhY. ____ ::•Ir. __
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date.

Facility Number: — Date of Inspection w
dor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
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 permanentitemporary cover?
Additional Comments and/or Drawings: -
� D
❑ Yes VJ No
❑ Yes No
❑ Yes 4NO
❑ Yes dNO
❑ Yes o
❑ Yes No
❑ Yes No
05103101

'WIN Sl©n of water ty
h' '` = = U: Drton o#Soil and Watcyr CanserVatt
Cr A�giiC
Type of Visit �Gompliance Inspection Q Operation Review O.Lagoon Evaluation
Reason for Visit ql�Routine O Complaint O Follow up O Emergency Notification O Other U� ❑ Denied Access
Date at Visit: / 1 Time:
Facility Number '? 9
Not Operational Q Below Threshold
13Permitted 0 Certified ©Conditionally Certified [] Registered Date Last Operated or Above Threshold:
County:........ �a�:.................... Farm Name: Qli.Y..►11�..�:.............
. ................... �....... ........ V.............I.......................
Owner Name:.... �.....�.: ...a ...14? .!^. ... ....��^.... Phone No: .......................................................................................
Title: Phone No:
Facility Contact: .................................................................................................................................................................................................
MailingAddress.............�.............................................:.:...................._.............._..._._.j......`..........i.......�................................_.._�...._.............. :...............-•--
Integrat........... Onsite Re resentattv....r_-,___,-......
Certified Operator:................................................................................................................ Operator Certification Number:...............................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• ���
Design Current 'Design Current Design Current
Swine . Capacity Population Poultry 'Cavacitv Population Caere Ca aci _,..Po ala 61i_'_
Wean to Feeder 10 Layer ❑ Dairy
❑ Feeder to Finish JE1 Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Cdj adty
❑ Gilts
❑ Boars TOW SSM
U.
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area
= Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
ID Spray Field Area
Discharges & Stream Il mpac
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?
— Jva _.
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes No
IV
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes R(No
Structure I Structu : 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ...........1.3. .............. 3.
.............................
Freeboard (inches):ye,� baL�
5100
Continued on back

Facility Number: ^ Date of Inspection Printed on: 1/9/2001
S. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion, ❑ Yes k No
seepage, etc.) /\
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes
�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ONO
8. Does any part of the waste management system other than waste structures require maintenance improvement? ❑ Yes TqO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ``
elevation markings? ❑ Yes �NO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes M10
11. Is there evidences ofoverajp�p'licati ❑ Excessive PondingY❑ PAN ❑ Hydraulic Overload ❑ Yes �o
12. Crop type 4 1) �f X V & 1� L S f 4 AP � 1J� 1.��
13. Do the receiving crops differ with those designated in tX Certified Animal Waste Management Plan (CAWMW.
❑ Yes
o
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
❑ Yes
o
15.
Does the receiving crop need irprovement?
❑ Yes
[ o
JiQ`
16.
Is there a lack of adequate waste application equipment?
❑ Yes
o
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yeso
tNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yeso
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
CO
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0i0
24,
Does facility require a follow-up visit by same agency?
❑ Yes
4'Po
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
viQlaign�s'o�r deficiencies vtre nQte�l d>riiig this"visa; Yop wife �•eciye iio #'u
carires ' deace: aboirt this :visit.
Comments: (refer to grtestiitn #)e Explain any_YFS amswers and/or any recctmmei4dations or-'
r:auy the rooimeafa
Use 4 wings of facility to.bette explain situations (use additional pages as aecessruy) „`
u
5;
Waste
�a ,vv�oNrk,t.s� O 41
V� 1
z r v. 1 I •- 11, —` -1 1 1a I
Reviewer/Inspector NameAr
eg
Reviewer/Inspector 5ignatur Date: t I - a) S/qp

Facility Number: Date of Inspection / l Printed on: 1/9/2001
r-�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes I 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 XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes PN 0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes
5/00

_ Division of Water Quality
O Division of Soil and Water -Conservation
Q Other Agency -
Type of Visit Kcompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit JQFRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 09— Time. 1©.'�Printed on: 7/21/2000
Facility Number
Q Nat O erational Q Below Threshold
Permitted Certified ❑ Conditionally Certified [3 Registered Date Last Operated or Above Threshold /�
Farm Name: -. .... .... �11'�1!k-s.................................................I.. ............. County: � ........................ a............
.......
Owner Name:...' J�'.!�............ Ti�'�f��. Phone No:....ry ......e Gtlr...n.��� ..................
FaciEitr Contact: Givlilt, Title:......t �'k ............................ Phone No:...............................
r.........................................
:Mailing Address: .................................... ..........................
Onsite Representative:..... LtJ't J ��
�i'... 5 �!�-(Ll.. Integrator:.................dl...........................................-............ .......................... ........-.
Certified Operator.... ............... ..... Operator Certification Number:.......
Location of Farm:
I I�
,j Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude C�• �� �« Longitude �• �` �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder 6 11,p ❑ Layer 1 1 Dairy
❑ Feeder to Finish ❑ Non -Layer I I❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lug...n Arra ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNO
Discharge originated at: ❑ Lagoon [ISpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
it. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes
[I No
%yfT
-
❑ Yes
❑ No
❑ Yes
[(No
❑ Yes
Dkfgo
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes xNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
36'
Identifier: ........... .Z.-.......................... ... ................................ -........... ........................ ...... ... ................. ..-............. ......-.......................
Freeboard (inches):
5100 Continued on back

Facility Namber: l Date of Inspection Q I'riuted on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures ob crve '? (ie/ trees, severe erosion, ❑ Yes IONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes PNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T Do any of the structures need maintenance/improvement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes J�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ((No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes RNo
11. Is there evidence o over application? ❑Excessive Ponding ❑ PAN ❑ hydraulic Overload ❑ Yes IWNo
12. Crop type�x ��C7
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes j No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes A No
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel 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?
: CVO V10�3tldris'ok d0ricier tk� -*( Iri - h6 eil• cl&i id �bis,vlslt. • :Y:oi Wi" •reef *0 iio �UTthe� • ,
curies orideiice: abi f this visit ............. . . .. ... . .. .
❑ Yes P010
❑ Yes PNo
❑ Yes [<No
❑ Yes E(No
❑ Yes ONO
❑ Yes No
❑ Yes f(No
❑ Yes \ o
ElYes 0
ElYes No
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):
'e,�L `. / a _,W� 01 y�h�'S / �vil1 �c
J
Pap# 1e— ?-ro
rd �rC `ie
s
Reviewer/Inspector Name Z/ �% 52
Reviewer/lnspector Signature: Date: 5100

Facilitv�Tumber: g,l-:kw Date of IiLspection-
Odor ISSUes
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ElYes (No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 9No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes YINo
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 y-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 T'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes PINo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 9No
3-daltlonat Uomments and/or Urawrngs:
PI
I
1�4- 1 (o)

Drvtsion of Soil and Water Cgnservatton -` Oper atom Revrew
13 Division of Soil Arid Water Conservation - Compliance Inspection _
+"Dtvisioit.of Water Quality - Compliance Inspection
` - t
Other Agency -Operation Review.
I;2�,Routine Q Complaint Q Follow -up -of DNW inspection Q hollow -tip of DSWC review Q Other I
Facility Number
Date of Inspection a
Tinic of Inspection 124 hr. (hh:mm)
© Permitted 0 Certified © Conditionally Certified © Registered 113 Not Operational Date Last Operated:
r— �4
FarmName: .......................................................................................................................... County:
Owner Name:�'�... Phone No........ • Q..Q..
r
'75..................................... ........... ........ ..` L ..-.-..........-...-... ^. `�'�
Facility Contact: ...�`''. 7 the �(.vs.-.'r.............................. Phone C'�'�q�
flailingAddress: .............O...................................................................-...........-.......,...........:.......................`.....`......-..
Onsite Representative: Integrator •...............-............... --.. . .
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
......................................................................................................................................................................................................................................................................... T
Latitude 4 .4
Design Current
Swine Capacity Population
Wean to Feeder
6qCU
O
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
I
IEEE]
Longitude
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes NNo
h. II' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes 'O'No
c. It• discharge is observed. what is the estimated floe' in Ralhnin?
d. Does discharge bypass a lagoon system? ❑ Yes [R�No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts to the waters of the State other than From a discharge? [].Yes JA No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes VNo
Structure I Structure 2 Structun 3 Structure 4 Structure 5 Structure 6 \\
Identifier:
Freeboard (inches): I
1/6/99 Continued on back

r
Facility Number: 31 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes XNo
(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? XYes ❑ 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 top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes 1XrNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [Xio
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes XNo
12. Crop type ` �.... r... ...
1-.............................................................................................................................................................
.!?.... C�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. Does the facility lack wettable acreage for land application'? (footprint) ❑ Yes NtNo
15. Does the receiving crop need improvement? "Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes RNo
Required Records & Documents,
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes CKNo
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 �XNo
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) N(Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes I,No
21. Did the facility fail to have a certified operator in responsible charge? ❑ Yes allo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes W"No
23. Did ReviewedInspector fail to discuss review/inspection with on -site representative? ❑ Yes gNo
24. Does facility require a follow-up visit by same agency? ❑ Yes [KNo
El XD.vialations or. def cie' ' des .were noted durin' f ii' - ' isit.' You �vilfr- e1v... further . ; . .
correspondence: ebout:this visit.; ; ; ; ; ; ; ; ; • ; . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any
Use drawings of facility to better explain situations. (use additional.pages as necessary): Afy L - - p,
W111 rev-2� 1\r-@-
rj> K�� r�� �e� cam►. app-�ic��
rG-� . .�J � ' L ti-,$ 2d�s � � 1.-� •--r-�,''�' e "'`4�*�-� -mac �-,
y�e'..
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� _ T Date: ! i 1 11/6/99

Division of Soil and Water Conservation [3Other Agency
Division of Water Quality
Ili Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other ]
; ., �,��„ �r
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
© Registered Certified © Applied for Permit © Permitted 0 Not O erational- Date Last Operated:
Farm Name: .......
...r.......................... County:.................... ............................
...................4..........................................................
1 ;
Owner Name: ...... 1j?�._`-t..... f.�'.... •.... Phone No: ��..'-......�................................
Facility Contact: ........................................................... ........ .. Title: ....... Phone No:
..........................
6_.
Mailing Address: T0 i.�v ........ C •••a`..• ... ................... I.........................
Onsite Representative: .... 1G.................................................... Integrator:..... .............--
Certified Operator ................................................... .............. - ........................................... Operator Certification Number:.------------...--...
L ttn o Farm:
�..��., ..........,..,...r... .........................................................................................................................................................................................................................�
e
Latitude Longitude �• �' �"
w Desi Cti�rent Desi Current " Dest n Curren
gn
_ S�vme _ Ca acrt Pol Matron � ; r` Capacity Po�
P PotiltpulattoflCattle Capacity Populattan r
s.. X
Wean to Feeder 00 ❑ Layer El Dairy
❑ Feeder to Finish ` . ❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
I[] Other
❑ Farrow to Feeders ,
z
❑ Farrow to Finish Total Design Capacity':
❑ Gilts
❑ Boars a Total SSLW
e
IL
Number of Lagooas / IioltLrrg Poads® ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
❑ 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
Wo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
JX No
c. If discharge is observed, what is the estimated flow in gal/min?
kYA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
WNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
�No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
(. 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
NrNo
7/25/97

+\ / acility Number: 3 1 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes b6o
Structures La oons oldie Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 9No
StrureI Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identi Fier:
Freeboard(ft): ........... ..1.: ..........................................................................---.................................... ....................................
....................................
10.
Is seepage observed from any of the structures?
❑ Yes
OdNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
DdNo
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
XNo
Waste ApRlication
14.
Is there physical evidence of over application?
❑'Yes
[XNo
(If in excess o MP or runoff enteriVgwaters of the State, notify DWQ)
15.
Crop type r.....� .......................................................................................................................................................
�... .
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
qNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
4No
18.
Does the receiving crop need improvement?
(' ,Yes
❑ No
19,
Is there a lack of available waste application equipment?
❑ Yes
ONo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
NrNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONo
22.
Does record keeping need improvement?
tIrlYes
❑ No
For Certified or Permitted Facilities Only
NfNo
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
1�(No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
ONo
0 - No'violations' ote deficiencies. were- noted• during this: visit. You 4ill iied've• no•fiirtlier' :
c0re9p4dde*e dlaout (his.visit Visit,'
FL
t�
Ova t„x�rw. &PA
bcrQ 1-4� aD(L,�_cjj1Z_4P U­A1�_-
fog i-•tQ -elf �1� (�'2 r_`�d `�°p
IL
6-h _1�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

u❑ DSWC Animal Feedlot Operation Reviewh E
DWQ Animal Feedlot Operation Site Inspection rF�
10 Routine 0 Complaint Q Follow-up of D%VO inspection 0 1' ollow-up of DSWC review O Other I
Date of Inspection Z -7
Facility Number 6 `7
Time of Inspection '.(10 24 hr. (hh:mm)
M Registered 0 Certified [l Applied for Permit © Permitted 113 Not Operational Date Last Operated: ...
Farm Name:......... f.. ..... r.,rrxis..................... .............. Count}':.....6....4x
....... �!h.....
Owner Name ' f. i.... —
yy 1 g 0) 2%- Liss
• .k:V.t�. k�t.t.� �tltl(��..d':....[�'vy.......�r..1ka.hS............................ Phone 10:... ................................................................
,
Facility Contact: ! Title:
ox1f~.......aY��................................... Qinl?s,tr................................ Phs�ne l�o:..IO 2�.G.b19G.........
MailingAddress:...... 3-a.....:rc►f..!:jD,r.......U................................................................ ..... M�...f:Lwe..,...me...................................... ..a.3 A.5`.....
Onsite Representative:...... 5................................................................. Integrator: ... .&1,6Lf.b..... ..-.E�!.,.S..........................
Certified Operator:....... fli.,-.i.�T......K-.... E-Vons........................................................ Operator Certification Number_.j�.m,?4 ........................
Location of Farm:
...... A'. 1w9.1.90..nae .... 6xx .... .... va .k -....nxrx....lt'..... -o ..... .r.,�...................
...... 5...... ax-.....1-. .....rs � � s ......ram. -....So lt...-s;.s�� ... , r'.............................................................................................
Latitude • 01 ` ®" Longitude 'li ' ' -
Design Current
Design Current
Design Current;
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity. Population
Wean to Feeder
I
I0 Layer
I
I
Dairy
❑ Feeder to Finish
I
JE3Non-Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity,
16,400
❑ Gilts
Total SSLW
j q pAp
❑ Boars
Number of Lagoons / Holding Ponds � ❑ Subsurface Drains Present ❑ Lagoon Area I0 Sprav Field Area
❑ 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
Discharee originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0 No
b. If dischar�,e is observed, dial it reach Surface Water? (If yes. notify DWQ) ❑ Yes 0 No
c. If discharge is observed, what is the estimated flow in -aUn-tin? JJ
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes Ca No
3. is there evidence of past discharge from any part of the operation? ❑ Yes `(JNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ,Q No
5. Does any part of the waste management system (other than lagoons/hotding ponds) require ❑ Yes Wo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes MNo
T Did the facility fail to have a certified operator in responsible charge? ❑ Yes OCNo
7/25/97 Continued on back

Facility Number- 31
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures f La oons Holdin Pottds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ............ ...�............. ........... -4 L........
Freeboard(ft) Z-�..z.............................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
MNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
IQ No
12. Do any of the structures need maintenance/improvement?
Dd 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
54 No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
JZ No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .'YI�U�c, . ............................. •....--..... Stt i-f- �.ra.-.........................
I
c4rle..................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
igNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
Q No
18.
Does the receiving crop need improvement?
79Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
19 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
ot ❑ Yes
No
22.
Does record keeping need improvement?
® Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
EO Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
•® No
P_ No.violationsor. deheiencies were noted -during this:visit._.You'will receive no further".
correspondence about this'visit.•'
is (refer.to question
Y
14. &,. "ex's a), (0. W. it 1 560j� 6-e rtisee��.
lvf &rmuaa u� 4W�il be im?ra+rcd'.
A- t- 5 I run ta4 to,500 - e n Spm 'Yteort�S. U? Soe j Dutne wC5 �c e�na lyS F� b�cc11� e
i 1n Ce�c'�'► ti (� ��t� • I ( i
7,3- Ctrki�ic&Ocn 6-rh r,,4f 0,N si t, 1Ped{f4c&6% sWj bQ ih �14,h.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� �- Date: q�x�97

- Site Requires Immediate Attention:
r res Facility No. �► l
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: —• / 1— , 1995(o
Time:
Farm Name/Owner:
Mailing Ai
County: __�
Integrator:
On Site Representative: U
Physical Address/Location:f%► C
f�...rao-- -
Type of Operation: Swine Poultry Carle' (4
Design Capacity: 2G-z) Number of Animals on Site: �Yd
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:ai' d ' _ Longitude:." �f Z Elevation:- Feet
3� ZJ a 1 g Circle Y-7s-Zr
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches or No Actual Freeboard: Ft_ Inches
0Was any seepage observed from the lagoon(s)? Yes o i o Was any erosion oiked 'es o> '
Is adequate land available for spray? or No Is the cover crop, adequate? (V or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (f�k or No
100 Feet from Wells? 6 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oI
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o
Is animal waste discharged into waters of the state by man. -made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.