310771_INSPECTIONS_20171231

NORTH CAROLINA J
Department of Environmental Qua

Type of Visit: C3 Co 70liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 'Ll_S] County: (�� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
^�
Onsite Representative: ^I-�A0J—D QiC&ClJ<
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 1 I 113
3
Certification Number:
Longitude:
Design Current Design Current
Swine C*apacity Pop. Wet Poultry Capacity Pop.
Finish La er
Design Current
Cattle Capacity Pop.
Da' Cow
Feeder
Non -La er
Dai Calf
o Finish
Z
Dai Heifer
o Wean
o Feeder
o Finish
U
Design C►urrent
D , P,oult , Ca aciP,o
La ers
D Cow
Non -Dairy
Beef Stocker
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [ "No ❑ NA ❑ NE
❑ 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
❑'>0
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

IrwilityNumber: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
1-#- L
Structure 3 Structure 4 Structure 5
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 property addressed and/or managed through a
waste management or closure plan?
Cd/No ❑ NA
❑ No ❑ NA
Structure 6
❑ Yes No ❑ NA
❑ Yes ZNo ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E/o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O/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
N,
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes�70
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps ❑ pease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. QWes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes d-11
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 1 21412015 Continued

F eili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
36. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes joNA ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes L2No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ONo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes eNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Jr —Jo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yesr]N"o
❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations .(use additional pages as necessary):
Q[,) SL-QOGE.
C"a ey
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Su (�.�/E`t'�7 n+�,.E�. �`� d ps i rL C t vv.1T(L C-toi CG C
C-G6L' Qe CA(W f—
Phone "l 1�/ �q� 1 ".7 loo
Date: _ 3 l221 t -
21412015

Type of Visit: 0 Cogbpliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: (9) Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: `DUpM0 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: DP�C:)O CAErtW,:[F,
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: I—) I b S
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pap.
inish La er
eeder Non -La er
Cattle
Dai Cow
Design
Capacity
Current
Pop.
Dai Calf
Finish
�p
Dai Heifer
Wean
Feeder
p
Design Current
I)ry P,oult , Ca aci P,o ,
La ers
D Cow
Non -Dairy
Finish
Beef Stocker
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
NJ
Othe
Other
Turke s
UTkey Poults
Other
Discbar2es 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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes YNNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes �/No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of lns ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes iNo ❑ 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: LAG-6od
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IZNo ❑ 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 environments 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 [j(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes YNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [21<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes LJ No. ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E]1No
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
Q
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Oth
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 01monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
El Yes
Yo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
3 O
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: -en I Date of Inspection: a oft
24. J?id 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
ZNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[]Yes
ZNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
VNo
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ YesVNo
❑ 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
❑ NA ❑ NE
❑ 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
❑ Yes
❑ Yes
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question##): Explain any YES answers and/or any additional: recommendations or any other comments.
Use drawings of facility to betterexplain situations (use additional pages as necessary).
RAOIFALt, .IOrsAc - FoYz_ �lL
Reviewer/Inspector Name: V c+ t PA' f{. 6 _
Reviewer/Inspector Signature:
Page 3 of 3
Phone( l ! [C " 1 3 tO
Date: 3 f .-w la
21412015

r1
(Type of Visit: O C pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 1 9 Departure Time: 3,Cj County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: n -r Title:
Onsite Representative: �tl Y c+ �P S �/1 L` H
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Region:
Certification Number: 1 7 / 6--D
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop:
Dairy Cow
Wean to Feeder
I jNon-Layff I
airy Calf
Feeder to Finish
3200
Dairy Heifer
Farrow to Wean
Design C*urrent
Dry Cow
Farrow to Feeder
Farrow to Finish
Dr, P,ouItry Ca aci_ P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 G-N ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
DNA
[:]NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No. ❑ NA [] NE
[:]Yes FNo ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

1.
Facility Number: 3 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes To ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): {
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �Noo ❑ 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 env' onmental 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?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes E:�No ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes [�fNo ❑ 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 0 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V-,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
d
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rN
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[A
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑70th21Does record keeping need improvement? If yes, check the appropriate box below. es ❑ No ❑ NA ❑ NE
[Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
rNo
22. Did the facility fail to install and maintain a rain gauge? ❑ Yeso ❑ 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: - '7 Date of Ins ection: S /
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 [✓ryes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
[Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Ej`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?
24. 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 [rNo ❑ NA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes [�j No ❑ NA ❑ NE
[—]Yes ]dNNo ❑ NA ❑ NE
[:]Yes �No
❑ Yes o
❑ Yes gNo
❑NA ❑NE
❑ NA ❑ NE
❑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).
c� O (Cf 6 n tQ 0r `I9 Prcxcrrj- Pl clS,b n on k­e4CA
�re /vrS
Z1. �/o Sl� Gi IYs
� t e � Ala S {e �¢,.tit l vs's
JA,
b ` 0
n I' +` l /f4 r P �o� �S
Z S (9 e 5t'4jj r S�ve/
Reviewer/Inspector Name:
Reviewer/Inspector Signature: `'` 1e0! "A
Page 3 of 3
Phone: j o 7-71
Date: /
21412015

ms�
1)
Type of Visit: Q Capnphance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: S 6 Arrival Time: a 5 Departure Time: 9 County: Wpt_,Zd Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 1D{ygZ-p C�_4 E ,,ttj I r1t Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: k 11. <S 3
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
?.moo
Da Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P,auIt , Ga aci P,o
Layers
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Twke s
Turkcy 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 ZNo ❑ NA ❑ NE
❑ Yes
0 No
0 NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
E2/No
❑ NA
FINE
Page 1 of 3 21412011 Continued

Facility Number: 3 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R� 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 666-10
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? Eye s 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 environment I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes V ❑ 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 7No ❑ 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 ZNo ❑ 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/Sludgc 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): _ L
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes gNo
❑ NA
❑ NE
Required Records &Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 0 N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 01"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 I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �Zo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: j
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 YNo ❑ 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 E�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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)
[:]Yes © No ❑ NA ❑ NE
[:]Yes O No ❑ NA ❑ NE
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
dNo
❑ NA
❑ NE
No
❑ NA
❑ NE
❑NA
❑NE
o
[/No
❑ 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).
C,d 0 Sm T E 0j O>J tWASte Vq N Ak_YS Xf �,O p,aY.s To Gc r SLO n
A��L' 11 +k ss wNEn1 SCrO zs 1L �� jL(_vAoJCD ao,-^ cOAs-t AL.
Reviewer/Inspector Name: '—TOW rkz_�S cu1
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( 9 10 T
Date: C Ida
21412011

�' "' � Di'vi-sion of Water Quality
'Facility Number - Division of Soil and Water Conservation
© Wither Agency
Type of Visit: WRoutine
pliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: I q Lf�9_ I Departure Time: D 3 County: VWZU Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: %_Dq,n.o CN �-ST'Nol
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design C►urrent
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design C►urrent
Capacity Pop.
Wean to Feeder
I INon-Layer I
Dairy Calf
Feeder to Finish
27o
-3 oop
Design Current
Dr. P,oult . Ca aci P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: T
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 ['J/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑j �Na ❑ NA ❑ NE
[—]Yes YNo [DNA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection. Z hi 1
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&m&3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z�✓
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ej 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 environments 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 F:3/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3"'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
0 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 dNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3"'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
] Yes
[Z No
❑ NA
❑ NE
❑ Yes
[;]No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes C:r&o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check he appropriate box below. [Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stacking ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes P�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciii Number: 3 - T71 Date of Inspection: l y t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EfNo ❑ 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 EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ 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 P/No ❑ NA ❑ NE
❑ Yes [JNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
[/] No ❑ NA ❑ NE
rNoE3/t❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or: any other. comments. .
Use drawines of facility to better explain situations (use additional'pames as necessary).
9 J,) ntiCSSC-.o JL*Jc z olz wASZ AfJALVSZf. TA V-_G SAv✓ PL-C S 3 -mmU -�Ea R htz 10t.✓,�i
-Ti (2)VC- i— Row COPS.
Reviewer/Inspector Name: J O K r'i ao Co-
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: O"Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 7Routine Q Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: ��P Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: DA11a U ES-W91t Integrator:
Phone:
Certified Operator: Certification Number: 1 f
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
J
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D , P,o_ultr.
Design
Ca aci
Current
P,o .
Dry Cow
Non -Dairy
Farrow to Finish
JLayers
I
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

acid dumber: - Date of Inspection: Z-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0No ❑ 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 tNo ❑ 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 en ronmental 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 YNo ❑ 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 YNo ❑ 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?
incorrect
11. Is there evidence of incorrect I d application? If yes, check the appropriate box below.
ZYes
❑ No
❑ NA
❑ NE
❑ Excessive Pondir Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2!f 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
CdNo
❑ 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
[DrINo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[/No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. jj"Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard [Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
❑ NA ❑ NE
Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

acili `N mber: - Date of Ins ection- S
24. Did t)ie`facility fail to calibrate waste application equipment as required by the permi . ❑ Yes VXo
o ❑ 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 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 �FNo
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 [D�f4o ❑ NA ❑ NE
[:]Yes dNo ❑ NA ❑ NE
❑ Yes ['' No ❑ NA ❑ NE
[:]Yes dNo [DNA ❑ NE
❑ Yes �o
❑ Yes �FNO
i�o
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑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).
?,) Osk.E WALL NEEOS W07.k 00 GKASS Cave , WAVC wacie.- 0owE ,n, 3oDA js,
it.) Our fuL.t. ark ►d''► OAAr>t- )a RaD N"DaAutSC, ovEKJ_0R9. No S -C- �2 �IJ 4EtA
,7 ui-c_. T rM t o 3 !a K
wASt4_ ArJAc-AS S Ca�Ea �Cr lr✓i�E� �F Z � M S8P, -W Pta_- SR"eLC CV'Cg.'
3 vwi 4S.
5L,.v0g.(- 5U"C'DwX gut- INdr FaL>uD, CALk-- Dt.-<A? 6j+4Cjc)LzcATCD, 1:� Ndt, HA�iE Nky--
ztp Dfl�s,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
jogty 56wax,
Phone: Lilo 6 1VP
Date: S
21412011

r
Facility NuinlierIX'
Division of Water.q
Division of Soil and
itv -
ter'Consen at
win
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I li Arrival Time: �l Q� Departure Time: County: T Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ' Title: Phone No:
Onsite Representative: DAV.L Q C.HEST 0 Vg Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ . ❑ Longitude: ❑ 0 0 6 0
Design Current Design Current ~" Current
4 . -PSIg
Swtrie °` Capacity Pgpulation ,We# I'ouliry Caacity Populahori' Cattle m Capa'city�;Population
❑ Wean to Finish
-�•�.:a_.�_ .
❑ Wean to Feeder
Feeder to Finish
3 CS "" ' _*
',-f,a
❑Dai Heifer
❑Farrow to Wean
-;
❑ D Cow
DryPoultry
❑ Farrow to Feeder
" �'""
` ❑ Non
❑ Farrow to Finish
❑ Layers
-Dairy
[I Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
Pullets
❑❑
❑ Beef Brood Cowl
Turkeys
3.Other - Turkey Poults
❑ Other ❑ Other
mber�of S c#u es
❑ Layer " ❑Dai Cow
❑ Non -Layer , Dairy Calf
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
dNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
E,] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ia NN
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L`J No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

i
Facility, Number: 3(— Date of Inspection [ t
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: U4G_6Ol1-}
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 34
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ 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? El Yes 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require [] Yes LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
l d o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
VN
❑ NA
❑ NE
Comments (refer, ta:questiod: #): Explain any YES answers and/or any recommendatlons or any other comments
Use€drawings of facility to;better;.explain situations (use. additional pages as necessary)
n
Reviewer/Inspector Name Jo },j t j ��.� �: � Phone: 41Q (o —7 3��
Reviewer/Inspector Signature: Date: 1 " i
1) .,F 2 12128104 Continued

i kr
*Facility Number: Date of Inspection t I'
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
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L7 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections O Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes LNo ElNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes L'J"No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,[31, o [I NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElLd Yes No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [2'No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes [YNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EjNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
BNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
04o
❑ 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?
ElE Yes
/
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes [3"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 E No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes D No ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 I2,128104

Type of Visit O co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ( Routine 0 Complaint Q Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: G L.F L.Li! J Arrival Time: //W Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: ` Title:
^
Onsite Representative: , l Awls ' 1. N Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [ o [ [= Longitude: [� o = 4
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry C•_ap�acity Population Cattle Capacity Population
❑ canto Finish
❑ La er
❑ Dairy Cow
❑ can to Feeder
10 Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
51.Cb
3
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:Lj
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
ElLa Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharizes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ}
Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Eo
�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 31 —
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 23
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
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 40 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9< ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes E No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes G3"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
� o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
L"J o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Commentsrefer to geieshon #} Explain any YES answei-s andlor any recommendations orany�othertcomments
YLJse drawings of facihty�to better ezplam srtuattons {use addihona! pages as necessary) "" _ `
t ,r.�;.:::. �,c,. - "4s•- -
�E� Sow S�nnQ(� ST LAfi4
XW
ReviewerAnspector Name C]` :" r _ ;. Phone:
Reviewer/Inspector Signature: Date: 6
12128104 Continued

Facility Number: Date of Inspection l i
lkeauired 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
21. Does record keeping need improvement? If yes, check the appropriate bo below. L7 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application El 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 L'J No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E N ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes El NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes Z ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 7Np
❑ NA ❑ 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 LJ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes [ /No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes L�J N ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �lEl NA ❑ NE
El0
33. Does facility require a follow-up visit by same agency? Yes , /o o ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
12128104

type or visa[ U 7noutine
pliance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (I -I Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: zAym u(sr wn Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Back-up Certification Number:
o [= � Longitude: =° �, ❑
Design
C+.urgent Design
Current Design C►urgent
Swine Capacity
Po�ulatian Wet Poultry @opacity
Population Cattle Capacity Populafion
to Finish
❑ La er
❑ Dai Cow
Van
an to Feeder
❑Non -La er
❑ Dai Calf
der to Finish
o
1,60
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
Gilts
❑ Non -La ersEl Pullets❑
❑ Turkeys
Beef Feeder
❑ Beef Brood Co
PE113oars
Other
Number Otis Luctures:
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ I No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PTNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facility Number: Date of Inspection % o
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: CA6r0wPJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[](No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[?(No
❑ NA ❑ NE
through a waste management or closure plan?
ental threat,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir7yes
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[�No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
E No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElE Yes
�(
I No
❑ NA ❑ NE
maintenance/improvement?
i t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
dNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
E1�4o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
+) wolt-tc oW ' D4r_e UAL& STst �. 06QXD .
j50 W M.tPj-j- W O MIL .
0
Reviewer/Inspector Name C j eei Phone: `( SLSZS
Reviewer/Inspector Signature: Date: �.
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection L
o
i Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
dxo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
d1N o
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WD o
[INA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
04
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
L�'No
El NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P/No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
(;�'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
VNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional,Commeuts and/or Drawings
A.
Page 3 of 3 12128104

Facility Number 3 rj 7
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit gCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l► OS Arrival Time: Departure Time: County: 04401� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: i +►'K^41? u('YNI '# Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o =1 Longitude: = o = S �I
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
0 Layer
❑ Non -La ei
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 1-A 31,46
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Im acts
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 �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[�o
❑ NA
❑ NE
❑ Yes
L No
❑ NA
❑ NE
12128104 Continued

FaMity Number: Date of Inspection +► di
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
GI/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: CA606n)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 130
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
6No
❑ 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?
t Yes
❑ No
❑ NA ❑ NE
V Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ENo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
VNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0"No
❑ NA ❑ NE
maintenancelimprovement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Ej"No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Lf No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
[J'�No
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L ❑ 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):
11.) Put ,r6nnk (6 p SQZL 0J A F ew 6AP-k SPOTf, C4 *jTZWVC- Wbiz-k ,
2A.) lcctiP Ue? q of STo C,(La_0(r .
Reviewer/Inspector Name „sf o�A3 rhRrlEu, Phone: 01a) -M - 1, 97
ReviewerAuspector Signature: Date:

a
Facility Number: L — �%'tS Date of Inspection 3 t�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ZfNo ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
oNo
❑ NA
❑ NE
the appropirate box. ❑ WUp [] Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Z/Yes
❑ No
❑ NA
❑ NE
❑ Waste Application El Weekly Freeboard ❑ Waste Analysis El Soil Analysis El Waste Transfers
El Annual Certification
El Rainfall LI 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
LJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ENo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,_�(No
o
❑ NA
❑NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
WNoe
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,�/
El NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
7No
❑ 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
ENo
❑ 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
FNo
❑ 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
dNA
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

1. Facility Number 3 7
U Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit TRoutine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / of Arrival Time: Departure Time: County: DUPLXAJ _, Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: ?uenrr%t' e_NesTNyr
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = , = Longitude: ❑ o ❑ 6
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish 314" 1 33oo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischah raes & 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 Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ 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
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

f
Facility Number: 3 1 — 2 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ 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: Q4 L— .0
Spillway?:
Designed Freeboard (in): l $
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ICJ 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 RNo ❑ 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? U Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L7 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 Ll No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ❑'�;o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[11 Yes
❑'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[Jl�o
❑ 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
E2(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):
?.� Wo"(_ NAi 13EE)V ZoW+ ON biKk wAU-9. STCLL WEC--nrb} FlvcAsf e.Or-sTx#jE16 Aw) Tf P^*
You )+off CFEoR.T.
a►�'crFl� �Cizfi �vP I �1C=0E8 TOILCo�DS Ato►.►(� w.LsN SrackstJ p,� GNSrstF o
.rNfPEcrio�,-
APR..- MAY Ala wAstE ANALYfXr ]vdt G0J(*9_" 06 ov62 AW PLEASE I.SE AMoAE
Reviewer/Inspector Name �i ONP Phone: «�� i %94 .... 73 W
Reviewer/Inspector Signature: Date: Ylzd G
/ 12128104 Continued

Facility Number: 3 — J7 Date of Inspection 2b 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, checl the appropriate box below.
❑ Yes
2 No ❑ NA ❑ NE
❑ Yes
IS No ❑ NA ❑ NE
2/Yes
❑ No ❑ NA ❑ NE
❑ Waste Application El Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Annual Certification
El Rainfall L�J Stocking ❑ Crop Yield ❑ 120 Minute Inspections dMonthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Otherlssues
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 reviewlinspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
nal Comments and/or Drawings:
❑ Yes
E❑
NA
❑ NE
El Yes
�N�o
❑ NA
❑ NE
❑ Yes
P<o
❑ NA
❑ NE
El Yes
�o
❑NA
El NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes [Z/No ❑ NA ❑ NE
❑ Yes �U'No ElNA ElNE
ElYes LJ No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes L"I No ❑ NA ❑ NE
❑ Yes
[,;_, Ko
❑ NA
El NE
El Yes
03 No
❑ NA
❑ NE
12128104

Facility NumberUDL4=1
V Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
4;RRoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: I a4310(, I Arrival Time: �.S~ Departure Time: County: .1/aetziJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: DAvIiD churpcIay Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= 0 0 { Longitude: ❑ ° = ,
Design, , ;,Currenty. Design Current ©esign, ., Ci rein)
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity ; Popula.tio
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean Dry Poultry.
❑Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
•Other
y ❑ Other 1
❑ La ers
❑ 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?
❑ 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?
Page 1 of 3
❑ Yes 2/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
P
El NA
[I NE
El Yes
2N,o
❑ NA
❑ NE
12128104 Continued

ti
Facility Number: 31 — ? y Date of Inspection S ry
' 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: Cis 4 001
Spillway?. -
Designed Freeboard (in): !.s
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LJ 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
RfNo
❑ 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
ental threat,
envi7yes
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 04 ❑ 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 ENo ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZfNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No [I NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O 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) � t11�%A (�� &0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
EjNo ❑ NA ❑ NE
Q/No ❑ NA ❑ NE
dNo ❑ NA ❑ NE
E(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)
►+J "S' NbE' StAertovrw GkASS Lx--TMR. Ta OwQ •
6% Lzo(v STP-rm cv- W04A-T rAK t5 W 1' TJAE
:'A') V*EP r(,daGE S u,R, &qj C.ALXA(tAcso•.► WO Ar►MAL c "-T "=ck4 2Z.c-a-oS . arCC--NJ 4>64E .
Reviewer/InspectorName I s `J (:Aa.P1(_-tL' Phone: �qlD) ?46
Reviewer/Inspector Signature: ^ Date: l0(1'
rage a of s ZZ/Za/vy t1unfinaru

� y
Facility Number: 3 — ? Date of Inspection Z 3 Oie
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes YJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ No ❑ NA, ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
12Yes
❑ 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 Inspection❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
21N'
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
Yes
ElL
�o
J No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[!I/NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
BIN.
❑ 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
����
[�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
W 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?
El Yes
LJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LJ No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

___ __�_— Q� Division of Water Quality
lapeffwaumell_3 / Hj
isionof Soil and Water Conseer Agency
Type of Visit qcompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: %: rJ Departure Time: 2�35�� County: P1-411 Region: alllea
Farm Name:%D L AV - Owner Email:
Owner Name: ^� —5 �f/� S�NLl Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: z2Azzi7o
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
r
Integrator: , Xas) s
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 =61 Longitude: = o = 6 = it
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
/Q Feeder to Finish coo
❑ Farrow to Wean i
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars ,
Other
❑ Other IT
❑ La er
❑ Non -La er -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes W1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes &No ❑ NA. ❑ NE
❑ Yes X No ❑ NA ❑ NE
12128104 Condnued

T 1+acilityNumber: —22VDate of Inspection f15
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P 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 JZ 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?
VfYes ❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
10
9. Does any part of the waste management system other than the waste structures require
❑ Yes ,E� No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Z No
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes Z 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 Drifl ❑ pplication Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;a No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
[21 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA
❑ NE
�-G'i4/�55 Co✓��tG-� �.►�PRo✓�mE.r, N��F,O ��✓.J�f;� //L��Ci�acc. /�
P£XE NEFO e /PE �77,p Ci¢� p v �R, iV /'�P� ©r>44T
Reviewer/Inspector Name Phone. ZZ
Reviewer/Inspector Signature: Date:
12/2"4 Continued

.'r
• Facilit�-Number: :3f —� rZ Date of Inspection o5
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 21 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 7 No ❑ NA ❑ NE
the appropirate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V1 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
JZ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
m No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[21 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
R3 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IZI 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
LZ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
JV
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or. Drawings: .. .
21sz,� �i2/LzG ,g7rv,� l�Ecv2Ps C�2/1 Z� _
12128104

0
Type of Visit ?5 Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit /Routine Q Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number hate of Visit: 3 (0 C) Time: �
� 0 Not O erational O Below Threshold
© Permitted [3 Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ... ._ ......
Farm Name: �A!!lf h' :....,!!t ...�1.
Coup • ... ..�.P� ...�........._.��...... .
Owner Name:
............................................... Phone No:
MailingAddress: .................... ....................._..........---•.-------•..-.........._...........W........_
Facility Contact: ....._........... ........... ...... ... Title:.. ..... _.... .... Phone No:
Onsite Representative: ,Q +± -._ E53 tJUT ... Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` 49 Longitude • ' «
stgm Current ; Deyzgn Current ~f i?estgn j iCuss
Swine Ca 'act . Pa elation P� y. =Ca-a`ei Po alation Cattle. Caeacity Pnnnl
Ex—ean to Feeder
-:
❑ Layer
Feeder to Finish
200
37.00r
:
❑ Non -Layer
Farrow to Wean
-
❑ Farrow to Feeder
Other
Farrow to Finish
s es li
F
Gilts
❑ Boars
A' ' Y``P Nnnsber of Lagoons
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes /No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes f"o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b-
Identifier: _...._A ..................... ..._.................... ........................._------..........................
Freeboard (inches): as
12112103 Continued

jFacWtyNumber:,3j1
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes INO
❑ Yes INO
/Yes ❑ No
❑ Yes V64o
❑ Yes Vlo
❑ Yes 9610
❑ Yes ZNo
12_ Crop type CSf! AgmAW LY 11694EED
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 VNo
b) Does the facility need a wettable acre determination? ❑ Yes VNo
c) This facility is pended for a wettable acre determination? ❑ Yes JdNo
15. Does the receiving crop need improvement? ❑ Yes X,No
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes RfNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes OfNo
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 P(No
Air Quality representative immediately.
Comments {refer to gnestion #) E�cpla:n any YES answers and/orany recammendaZaons orany other comments.
,Use drawtngs o#'fac�ty�to better explaui satnatioas. (ttse additional pages as tie_ cessa�ry) ❑ Wield Copy ❑ Final Not es
'� G C�4SS w E 2 CIOLAG ►J W A u-S NEED ZMf 9oU��
4wOE2 T6 Da Sc.UDC-e SU?-VCy a? APK' 2�
L 6o !L &at�D .
ReviewerlInspector Name p;N -��
E
ReviewerAnspector Signature: Date: p O
12112103 1 Continued

Facility Number:Date of InspectionI311
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes XNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes Q�No
23. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes �No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONO
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes XNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes PrNo
27, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes XNo
28. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
N IDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) )dYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONO
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes /jZINO
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ YesNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes j�No
❑ Stocking Form [I Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain /
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit ZCompliance Inspection 0 Operation Review O Lagoon Evaluation I
Reason for Visit -olftoutine (:) Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilitv Number 3 i Date of Visit:
M Permitted O Certified [3Conditionally f! Certified [3Registered
Farm Name: -Tor" r % 4 6_1 LeS4 r! tl --9 1
Owner Name:
Mailing Address:
Time: 15 ' 1 J7
Date Last Operated or Above Threshold: _
Counh':ye It ^
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: D A V es4p - V 0 _ Integrator: 8 ro w n'S or
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' C " Longitude
Design _
C-firr! R 1 sign Current Design Current
Swine Ca aci
P,o ulat'oa Pogltry Ca aclty P,o ulat'on Cattle Ca acity P,o ulation
❑ Wean to Feeder
❑ La er
❑Dai
Feeder to Finish 3 Z
❑Non -Layer
i
❑Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
TOtal Dt ign Capacity
❑ Gilts
❑ Boars
T©taI SSL,W
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Number of Lagoons
Holding Ponds /Solid Traps
❑ No Liquid Waste Mana ement S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
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 ZNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: _ 1
Freeboard (inches): 3
05103101 Continued

Facility Number. .71 — 7 91
Date of Inspection 3 OZ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type C o e n hea4 So e h s 73 e.-VA�Cj �� �Sw� a �I 6 ra I
13. Do the receiving crops differ with those designat d in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
[--]Yes RrNo
❑ Yes )dNo
❑ Yes ❑ No
XYes ❑ No
❑ Yes �No
❑ Yes ZNo
❑ Yes ,EfNo
❑ Yes RTNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Zf No
❑ Yes XfNo
❑ Yes ,21rNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ETNo
❑ Yes ONo
❑ Yes '21 l0
❑ Yes ErNo
❑ Yes,2'No
XYes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commeu s refer to quest,©n#) Eipiain am YES answers and/or,any recommend"adons of any other Coiniitents.�Not.
U9CdraWMgsoffacility to 64"1 - lain situations (use addhhonal pages as necessary) = oPY ❑❑Field C
7. a be4ar /'oLo Cever or.t �c.rolx W4rls Yet„Sc-
,e � reatf7D-% now qAooh 4o Cdose 6V 14 arPer-rs)aA1
Tke 1) ires 4d,-A,'� 4Lve 1,.0„,_se,s --nac 44e to jeefts dead 4n be
. A,-
ex4aa,Aed #6 Peeu9­4 derv-,ar�� -jo 1Aj001.. 6VOL -
11g , /Deed -�o ��vP sh�'o�,�.at-� i on .frog„ ;✓'r �a� bt-. dcs,'9v��►- w �,.c4 sC�uwS
;d�kl,el c, r. t cL-\ L-dere used 46 de4ee^A; -,e acme. ;ri tnAr
Reviewer/Inspector Name�L1.L; j
Reviewer/inspector Signature: nnizLk Date: 3 !S D Z
05103101 Continued

`i
Facility Number: Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ) No
28- Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [�'No
roads, building structure, and/or public property) /
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ['No
30. Were any major maintenance problems with the ventilation fan(s) noted? (Le. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ANo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes , No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments an orDrawings:. t _
M. T �, e Zea res 5 oo} •rnAVleS
S vtJ /Vove,'"bee- ZOD1 Sn,S A r_ 6kers)rtl1 AI,<of be SVILA
-�a use a wade qn Alys; s dot4e4 rry i-11�p:�-, (�O days aF "y Iti-,r�Jr�h
eVarl S —�D ��v�ot�e JAg, h;Aev c i °I/v1 1� �Gf at�t -4ZtP = i
have 41e qv,"I s'S da-leo Svq'*'-;'rMJ1 eta need �o be
SvrG -�o l�se �� Gn 4 � T�Q-
y�
3b2S /Uee4ed �a ilowe pl4tm4eA wheot4 a,, sc-ve�-a! Pulls
t P4A l0It 0'..1 jJ4�'iE Gaut . J'v1i_ r��PS�i`IfiH SQl/f � /Gf; !� 1p�
arp l � 4o JlneSe f ;ald-l. _4 ;J rotIOL,, 411f,
re4o4l,opN gvNd fla"14 -Ae crorS acGo�d;�� -la t tWe rlah
tis 4t,eSe A-ee reju►'red -
J
5100

�Di, i of Water Qualrty
Division of Soil and Water Coservation
n<
o,Qthee Agency
Type cf Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit VIRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3
3 Date of Visit:
Permitted [] ertified [3 Conditionally Certified © Registered
Farm Name: .....:5`r....!/C>/77 "..................................................
Owner Name:....�0�1.�.......... f .............................
Facility Contact:
Title:
MailingAddress: ....................................................... ............................. .............
ddress:........................................................................................................
Onsite Representative: ,,.l.._/?`o�i9 S �j��� l /V7...._.....
Certified Operator:
Location 'of Farm:
/Z
O Tirnr= ��Printed on: 7121/2000
10 Not Operational O Below Threshold
Date Last Operated or Above Threshold:
Countv: . t/,) ;A/
..................
Phone No:
Phone No: ,,,__•..
....................................................................
Integrator: _.._�I✓s
- Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �C�«
Design Current
Design
Current Desiga . . Carirr�t
Ca ci . Po ulation
Poultry Ca ' aci
Population Cattle - , _ Ca aci Po ulaoii
Wean to Feeder
❑Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer
I
❑ Non -Dairy
Farrow to Wean
'-
Farrow to Feeder
❑ Other
=' =
Farrow to Finish
Total Design Capacity
Gilts
Total:s%w .`
s'
Boars
�❑ Subsurface Drains Present �J❑ I,ag•wxn Area P Spray Field Area`;;
No Liquid Waste Management System
Discharo & Stream Impacts.
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure ; Structure 4 Structure 5
❑ Yes VNo
❑ Yes
No
❑ Yes
�No
❑ Yes No
❑ Yes
No
❑ Yes
VNo
❑ Yes ❑ No
Structure 6
Identifier: ................. I......
Freeboard (inches):
S/00
Continued on back

Facility Number: — Date of 10speetion /�%7J/h/ I Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Ex�ccessive Pondin ❑ PAN ❑ Hydrauuh Overload
12. Crop type���/YI Uii} I //TfftL?�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel 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?
:: �Vo • . iulations :oe defciencies -v�re jnotec]- during 4his:visjt: • Y:ou will -receive 0o further
rorris Tideii& about this :visit.
❑ Yes VNo
❑ Yes 5dNo
❑ Yes VNo
❑ Yes VNo
❑ Yes No
❑ Yes P�No
❑ Yes No
. A,�
❑ Yes No
❑ Yes o
❑ Yes No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
AYes ❑ No
❑ Yes UNo
❑ Yes No
❑ Yes b(No
❑ Yes �No
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes dNo
.,
A4, e)TAX
E -SEM
Reviewer/Inspector Name r f
Reviewer/Inspector Signature:,k7�— Date

Facility Number: Date of Inspection �/J� Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [INo
28_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property) /
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes tvNo
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 o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes '01
0
tia ominents and/or ra;;tngs:_
ZOd --S,
��✓�� �j ���J lit r; �nl ��
0 f� N
f� FEI°
7a
Z � a AW51 -his
&D �- 5
V
emu'O �-
l � B
�rF
0
a C �52 �95
41VI
5100

a
Division of Water Quality. �, f
Division of Soil and Water Cooseri anon
gk
Other A ency
Type of Visit IR'Compliance Inspection O Operation Review O Lagoon Evaluation
(Reason for Visit ARoutine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Uate of visit: %�-Zo' Time: l Printed on: 7/21/2000 10
� �-
Not Operational 0 Below Threshold
Permitted�Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ........`.DI^t C�t_QS �U11 County:.......��..t, 1 �i..Jt .............
-�j......................••-...•••...........................................................................................
Owner Name: ........ ` t ¢ 5�1�` U ..., Phone No:
........................................................
........ Title: Phone No:...._...
Facility Contact:................................................................................................................................ ................................................
Mailing Address: ...................................
Onsite Representative:........ G....... Ut....... ^P.I4.L!................................... Integrator: ......................................... .............................................
Certified Operator: ........................ 5Cy.-+"L4
p........................................-........ ...... Operator Certification Number:........................
Location of Farm:
A,
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° �'° Longitude a
Design Current Design Current Design Current
Swine Capacity Po ulation Poultry Capacity Population Cattle Capacity Population
❑ can to Feeder ❑ Layer JEI Dairy
fSW
eeder to Finish 3z ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Wubsurface Drains Present ❑ Lag-nn Area Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System.
Discharges & Stream Impactti
I. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharce originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance nian-rnadc? ❑ 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"
d, Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes o
Structure 6
Identifier: ....................•
Freeboard (inches): 2�
5100
Continued on back

Facility;Number: .5 —'_ Date of inspection ,FFJ__ d Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
KNO
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
6NO
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
KNO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
"�N0
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
KNo
12. Crop type C (c C L Id
I3. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Rio
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
`®filo
((
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
,'9No
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNO
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Rev iewer/]nspector fail to discuss review/inspection with on -site representative'!
24_ Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Vo •violations :or deficiencies -*ere potted- during this'visit; - :Y:oix 'Wiil.teceive iio #'ukther' - ; -
corres�ondeince' about^ this visit. ... . ....... . ...:.:. ; .: .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
pour-. }re_eeMS to,, 1�1_ o00
❑ Yes �NO
❑ Yes o
ElYes No
❑ Yes 'No
❑ Yes W
0
❑ Yes r_ 0
❑ Yes CNo
❑ Yes F"No
❑ Yes rNo
A5 vv6 1 rfta� y,, ��'/�!'�°�q J��+n 1-,t, —7 la7cans 431 e-d j OLI �004-aS cz✓C"-0
1 okkozw cus p a, c; !�°J� 'Y �r}� 4 51��.� Fv'ee bo"'-, C si` 10 i hC4ke-_'5 5t
IV
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Col
Date: 1 I ""�O- OO 5/00

'-IFak9kyNumber:31
Bate of Inspection j-ZQ Printed
on: 7/21 /2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
*0'
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
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
1N0
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
`�"
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes No
Additional:l_ornments"and/or Drawings:
i
qV
5/00

r
Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
Facility Number I�
Registered %Certified ;3 Applied for Permit O Permitted
of
Date of Inspection
Time of Inspection
Other
24 hr. (hh:mtn)
0 Not Operational Date Last Operated
FarmName: ............... ........ .1..1-t-Si.Xt r_...4..................................... County:........ 1�.�il...........................................................
Owner Name: ...................... . Nt.1hl............C.V.. %Thu. ........................................ Phone No:..!`.1iA 1. 4�-.. �7..j.........................................
FacilityContact: .............................................................................. Title:........:....................................................... Phone No:...................................................
Mailing Address: ........ IN ........ s....... N. C....(.,1�.... .VIr .........................................
1....1J..5................................ ...�.4 �.....
Onsite Representative: ........._TOMV!rtt..... C✓.L.6VIr......................................... Integrator:..... &ardl& ..............................................................
Certified Operator:....................................1........................................................................... Operator Certification Number .........................................
Location of Farm:
Latitude 0'=° 0" Longitude 0• =' =11
Design_° Current
Design Current - Design Current
_
Somme` Capacdy Population Poultry Capacity; Population Cattle- �Capacfty Populahon,.�',
_ m
' ^n to Feeder
`rElFarrow
� ❑Layer ❑Dairy '::
er to Finish
A% ❑ Non -Layer -. ❑ Non -Dairy
�= to Weanow
t� ❑ Otherow
to Feeder
to Finish
f -Total Desigtt Capacitys-'
_ ❑ Gilts
a - Total SSLW'
❑Boars£
Y ^vXy ,
Ntmrber of Lagoons PHoldI tg Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area zi
'
4
ste;
❑ No Liquid Waste Management Sym
_ , .
General
L Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
1 No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Cl Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
}] No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
/
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

P
I Facility Number: 31 - 7 7�
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yesj No
Structures LLagoonsjJolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft):...........23 .............................................
10. Is seepage observed from any of the structures? ❑ Yes P No
11. Is erosion, or any other threats to the integrity of any of the structures observed? `" Yes ❑ No
12. Do any of the structures need maintenancelimprovement? P9 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
W No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
MI No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
{
Crop type s..............ir].iY itr....... ht�o4.1................... ...... 6.y.y., 1. - .................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
ja No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
�j No
18.
Does the receiving crop need improvement?
❑ Yes
J9 No
19.
Is there a lack of available waste application equipment?
❑ Yes
N No
20.
Does facility require a follow-up visit by same agency?
[d Yes
❑ No
21.
Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
❑ Yes
JR No
22.
Does record keeping need improvement?
RYes
❑ No
For Certified or Permitted Facilities Onh•
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
1PNo
iq
24.
Were any additional problems noted which cause noncompliance of the Certified AVVW?
El Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
EANo
❑ - No. violations°or deficiencies: were-ntited- during this.visit:• Yodwill receive, no-ftirttier- ;
: e6eresppndehn a about this:visit:•
11-h. t�,m-to- 000s o,, ot,4_z, dix,. welt S zvlr
fie. (41I d
f rese4ed.
tv-as o, 0m, wa�j
%z'z\OuN �o►� aJ
C 1 z b� s f.,o<,1�} COL
c�
or. a (b� a
S
S � I of co,4O tWd tot
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� �
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� �r*�
Will.. Cal(Ctl14�1
lvcf � a 4.w. eS,rr;o�o.�an
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�,
%'tcc,�•tif • �-V �SP� S� I
"cn,40� s �l� b� 1"Jk
CAS �„1
D�.
W: �,n�,;+n� Apr, IV c
2440-11—.
1/25/97
Reviewer/Inspector Name l , r`
Reviewer/Inspector Signature:' ��,� Date: ]�p[g

❑ DSWC Animal Feedlot Operation Review
®DWQ Animal Feedlot Operation Site Inspection
10 Routine 0 Complaint 0 Follow-up of DW2 inspection 0 hollow -up of DSWC review 0 Other j
Date of Inspect ion q 3
Facility Number .� � 1�
Time: of inspection 0 24 hr. (hh:mm)
Registered E2 Certified (3 Applied for Permit © Permitted [3 Not Operational 1 Date Last Operated:
.T ff -
Farm Name: ... L:A.✓'. ................grin e:.S.� .cn s�...�- ...... ....4.............................. County: ..... �,1. ri L.P- ..............................
. .!... L!
Owner Namte:........�. a.. �."`..0..5.............�.4�..� .5..�^.u.�"�. Phone No: �.. � �? .'....D ......................... .......1�...Z......... ..............
Facility Contact: .......... Phone No:
...............l!.--............................................................. Title:.........................................................................................................
Mailing Address:...... ..Gi......... S,........ .. .................,........ 4..E.!...0-1...Q�.....................
Onsite Representative:.... ........... �................ Integrator: ..... .n..S.................................................
Certified Operator.............................................................................................._... Operator Certification Number ........ .�...........
Location of Farm.
S?.r N..t~ : ... ..d�,e......1......i%±:?. ......1...........m�.�..r-n.. .,.y+^.u.. � ...... ,ry:�.! 3..... S.a.�l.3` ...�¢ .....(.� �':.... .................. .
..r........... ............... ....-----...----............ ................ ..............................................---HV
Latitude Longitude
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design . Current.,.
Poultry Capacity Population Cattle Capacity. Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds ❑Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area =
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes CR No
2. Is any discharge observed from any part of the operation? ❑ Yes allo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance matt -made? ❑ Yes ® No
b. If discharge is observed. did it reach Surface Water? (If yes. notify DWQ) ❑ Yes 91 No
c. It discharge is observed, what is the estimated flow in gallrnin`
d. Dees discharge bypass a lagoon systein'' (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 9No
4. Were there any adverse impacts to the waters of the State other than from a discharge'? ❑ Yes K No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 09 No
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design? El ,lallo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes &No
7/25/97 Continued on back

'\
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? KYes ❑ No
Structures (Lagoonsjlolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? Yes ❑ No
Structure I Structure ? Structure 3 ructure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): ........�.�..2............:...5............... J.....
10.
Is seepage observed from any of the structures?
❑ Yes
RtNo
11,
Is erosion, or any other threats to the integrity of any of the structures observed?
KYes
❑ No
12.
Do any of the structures need maintenance/improvement?
9Yes
❑ 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?
ff Yes
❑ No
WasteApaiication
14.
Is there physical evidence of over application`'
❑ Yes
1KNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crap type G. .tr........................................................................ ,A /.�1:..^...
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
9No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
M No
18.
Does the receiving crop need improvement?
J-Yes
RNo
19.
Is there a lack of available waste application equipment?
I&Yes
@&No
20.
Does facility require a follow-up visit by same agency?
XYes
❑ No
21,
Did Reviewer/Inspector fait to discuss review/inspection with on -site representative?
❑ Yes
['No
22.
Does record keeping need improvement'?
❑ Yes
O No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
($No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
&No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
KNo
[3, No'violations or deticiencie's.w'ere-noted during this:visit. Nou4ill receive no further
correspondence Ahout this:visit '.
Comments (refer tosquestion #) ,,Explain any.YES answers and/or any recommendations or any other comments.
u `` tti 1ex laes as necessa Ue dravngs ofaciltE tobeensitaions {useadtonal ry, "
g. rAA I S k u L.i• p v o <'
u o4 L"'e— 0., l +�L T�-- 1 e�-,--k l'�-4V � 6-k: to t/'p'Y-cJ
i x wL4 ✓+
EYe S i Q .. w a l t 6 ar4 G C 14- 1 i S k-0-0 LC( 4._L t o 1_ZJ R-L �-c( G.-+. L UL f j bM.
13 • Cre c� �► `� r-c T r: M6 t-�v ,t �-q 0 3 w +
t-o`_ u w j �f d ,� ✓ t a 0 d� d pw "'1 .
1 V r 0. i E-c 1 iwi. �/ tr a �-o V�Q C1 E L C� C!_ t C*
W !
w i 1 2 s elf �O f �r.� �e-�, P tL-r tt< a �v -+� e•� 9'i15�97
Reviewer/Inspector Name ' f
Reviewer/Inspector Signature: f Date: t �d

3 I.- 7q -3) - �-73
Site Requires Immedia Attention:
Facility No. —3t�
DfVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
40 DATE: a d 01995
Time: oZ : 30
Farm Name/Owner: 8kt&7 7 C�4rfc-c.c.
Mailing Address:
County: DL-tooh' A -
Integrator: O Phone: y1� 03 7 3
On Site Representative: _ �R./f� _ Phone:
Physical Addres s/Loc anon: ,A, G ,�•.� , I I ., , 3 01 4 p 3 ": [�A-&
t:�A 9^4 o.v &VEST 51,)' o
Type of Operation: Swine Poultry Cattle
Design Capacity: I,P oy Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3'V 55 t Longitude: 7 7 ' _' 03 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es No Actual Freeboard: -?, Ft. b Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? r No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or
Crop(s) being utilized: t,"K4, uvw -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:rc,
0 & X Lv;la" ( I-Y7 IV
Inspector Name Signature
cc: Facility Assessment Unit Use .attachments if Needed.
`IJ

a
Z 312 636 552
Z 193 115 935 us Poslal Service
US Postal Service Receipt for Certified Mail
Receipt for Certified Mail No Insurance Coverage Provided.
No Insurance Coverage Provided.
Do not use for International Mail (See reverse)
uF/�500 111,1
TOTAL Postage & Fees $
CO
Postmark or Data
V)
IL
LI
E
Do not use for ante ational Mail Sea reverse
Sera toT. CLAALL
AV l
txsce, state, a zt
f-P,. t a P
$ 3�
Certified Fee
PmWc ed Delivery Fee
to
1- 1
Whom & Date Daw-gd
F Paunw MCA
Dak, & Addressee's Adds
TOTAL Postage & Fees
r Postmark or Date CaQ
V
1