670039_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Date of Visit: Arrival Time: Departure Time: County: O• j 1 6W Region: w E IZ D
� 0
Farm Name: tA)-, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: d��Gt/n �, Integrator:
Certified Operator:
Phone:
Certification Number: 111 Lq
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
ign C►urrent
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
t) , P,ouIt ,
ILavers
Design C*urrent
Ca aci I;o P.
Dairy Heifer
Dry Cow
Non-Dai
113cef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
e. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 9No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA [] NE
❑Yes [:]No ❑NA ❑NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes tNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facil Number: 1 n- Date of Inspection: 1741
~Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[KNo
❑ 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
0 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
kNo
❑ NA
[] NE
waste management or closure plan?
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
V No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
OWNo
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
6To
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
6;
12. Crop Type(s): ��
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes VNo [] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes V No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes -X-IdNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [ y No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
Required Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check]
Yes No
LP
❑ NA
[] NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes KNo
[] NA
❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections EIS I udge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

Fac' ' Number: Date of Inspection: k
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No D NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes MNo DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No QKPNA ❑ 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:
❑ Yes k No E NA ❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes ,�No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes kpNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNo [] NA ❑ NE
Reviewer/Inspector Name: c 1v� Phone: ! D -761 U
Reviewer/Inspector Signature: Date: I ki
Page 3 of 3 21412 15

(Type of Visit: &Co7¢liance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 4Routine 0 Complaint 0 Follow-up Q Referral Q Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ; J 61JA tN C-_ LANce
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: ! (P 2
Certification Number:
Longitude:
Design C►urrent Design Current
Swine Cacit
apy Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
ci
C+attle Capaty Pop.
Da Cow
Wean to Feeder
Non -La er
Dai Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
lYe—s
Dr.V P,oult , C+_a aci_ P,o ,
jDryCow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
13oars
Pullets
Beef Brood Cow
Other.
Other
Turke s
I Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
El
Yes 0 XNo ❑ NA NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes gNo
N ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 214120.15 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
g/ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2 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): C�
5. Are there any immediate threats to theintegrityof any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en oental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Ynmes ❑ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes K "" ❑ 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes d/No ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V110
❑ 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):
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Ye
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
[] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EZ <No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElLaOYes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
YNo
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other•
21. Does record keeping need improvement? If yes, check the appropriate box below. �Ye's ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectioi 2 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? 0 Yes �No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
A Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes% Fl
o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes /No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes YNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA 0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to 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).
FAaL- S,96`r c*) rn1tc_ W .1. (1/C EIS
j, bJ C-C _9
�'O al Ec9 Td r'T_A'1jj--0
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
SLuv�'_�_ �i J��i S�JEcTk
Phone
re:Date:
Page 3 of 3 21412015

7
�A
Type of Visit: aCompli nspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: j Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �p—,t yti e— n c e
Certified Operator:
Back-up Operator:
Phone:
Integrator:
Certification Number: T �o ;>G z
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Wean Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dairy Cow
it
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
eeder to Finish 24
24O3
Dairy Heifer
Farrow to Wean
Design
C•_a aci
Current
P,o
Dry Cow
Farrow to Feeder
Farrow to Finish
P,ouIM
Layers
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
,__,
❑'[io
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
rNo
❑ 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

.t
Facili Number: jDate of ins ection: q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q 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): Z �,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ff No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F?I�o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes do ❑ 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� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑
Mo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[I —No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
D Yes [ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes FZNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes CiNo
❑ 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 [rNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [] No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

t
' Facili Number: 62 - 31Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E5<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes " No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [-]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No []'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 fNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
0­No
❑ NA
❑ NE
❑ Yes
M-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 necessar_y).
/(T: Cct4-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
6 y F_ ^^`-f...ffy
411, j V9 --.e (i
Phone: 71( 1 t 7
Date: 3 0 / r
21412015

f#
Type of Visit: (D Co pliance Inspection O 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: County: ps,lsj� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: DEWMA)L S pJ -C. Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C►urrent Design
Wet Poultry Capacity Pop. Cattle Capacity
La er Dairy Cow
Current
Pop.
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish 60
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , lout C_a aci P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: JDate of inspection: 3'
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):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes O/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 environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes UXNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ✓ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZN9
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
D N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Ot r:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [� o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WNo
❑NA ❑NE
Weather Code
Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: 3 '] 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 640 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
[—]Yes
2/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
dNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
2)/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
]/No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
a�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
fNo
❑ 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).
0402 5c,"" S11X-VE',� W T 4 rsb !�q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhonO/p a -- S
Date: ILI
Z 412 11

Type of Visit: tD Co ance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Z6 Departure Time: County: cWK04/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: D E W A'PC SM L.ANU
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Certification Number: NO
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine CapacityWet Poultry Capacity Pop.
Wean to Finish FiLayer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I iNon-Layer
I
Dairy Calf
5(
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P■oul Ca aci. P,o ,
Layers
Non -Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes �o ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: 7 - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 6 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure I Structure 2
Identifier: LA616rJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 t
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ErNo ❑ 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 [3/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes dNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes El No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes E�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 dN
❑ 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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rN
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: ,
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ l20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6/No" ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes F3/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 67 - Date of Inspection: cr 3
?;4. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes WNo
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
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
YNo
❑ 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
C�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
[:]Yes C3 No ❑ NA ❑ NE
31. Do subsurface tile 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
No
NA
NE
❑
❑
❑ NA
❑ NE
rO'�
❑NA
❑NE
Cf'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or, any other comments. M
Use drawings of facility to better explain situations (use additional pages as necessary).
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ( 4 g�
Date: ql;�
2/4/2 Il

Type of Visit: Q-Co pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:.J Departure Time: ® County: 0A.4f L W Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: JC W PAX-- S;M A N C& Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number: IL 2g
Certification Number:
Location of Farm: Latitude: Longitude:
Design CurrentSIMON
PCattle
Design Current
Design Current
Capacity Pop.
an to Finish
La er
Dai Cow
an to Feeder
Non -La er
Dai Calf
!Feeder to Finish
ow to Wean
ow to Feeder
Design Current
1) , P,oul Ga aci P,o ,
La ers
Dai Heifer
D Cow
Non-Dairyrow
to Finish
Beef Stocker
s
Non -La ers
Beef Feeder
rs
Pullets
Beef Brood Cow
Turke s
Turke Puultser Other
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
[:]Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
❑ N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesfNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0 Yes
L
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection: 21
Waste Collection & Treatment
4i 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
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: G
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �.c1
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
OINo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
EYes No ❑ NA ❑ NE
❑ Yes o/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmeor(al 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 jNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P�<o ❑ 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 JZ/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[De o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[—]Yes
❑
7�Io
❑ 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

Facili Number: jDate of Inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EJ No ❑ NA ❑ NE
A Is the facility out of compliance with permit conditions related to sludge? If yes, check O/Yes [:]No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E3failurc 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 WNo
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 ❑ 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 VNo ❑ 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 2No ❑ 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
o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LI 1V
❑ 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 afollow-up visit by the same agency?
❑Yes
Na ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or, any additional recommendations or, any other comments:
e Usonal pages as necessary).edrawin s of facilty to better explain situations use additi
17_ ?v 00 JLUPCC �b pa RA7� f r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q11
Date:
21412011

Facility Number (o�
Division of Water Quality
O Division of Soil and Water Conservation
Q Other Agency w«
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
ArrivalTime:1 R4S7 Departure Time: County: MA.ISIAtJ Region:
Owner Email:
Facility Contact: Title:
Onsite Representative: �C-WA`�1JE11i�1�-E
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ e = s = Longitude: = ° = 6 =
fi
Design ..,:,Current ,
5�yine Ca ace Po illation Wet'Poult '
P ty P _
❑ Wean to Finish ❑ Layer
El Wean to Feeder ❑ Non -Layer
Feeder to Finish '? I1'Loo
El Farrow to Wean Ury Poultry
❑Farrow to Feeder
❑ Farrow to Finish
!' ❑ Gilts
r ❑ Boars
" Other _
❑ Other C'
gn- Current
ctym .Population Cattle
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Calf
Lf Dairy He
-E] Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
N umber�ofgStruc
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 FINE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes d ❑ NA ❑ NE
❑ Yes Zo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

acility Number:
Date of Inspection 30 L
Waste Collection & Treatment
�. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L.. &60
Spillway?:
Designed Freeboard (in):
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Observed Freeboard (in): 33
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 94 ❑ 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 o ❑ 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 El Yes [2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes ba N ElNA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �2 /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑�'I o ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
E No ❑ NA
❑ NE
16.. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
El""No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
4, ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
570❑ NA
❑ NE
Comments. (refer to question.#): Explain any:YES answers andl©r anr y recommertditions oany othercommeiits
Use drawings of faeihty to better explain situations. (use;iddihonal pages as necessary) ,
µAL
.} 3a ch-+JS ro(L
Reviewer/Inspector Name
Phone:
q t6) —73qy
Reviewer/Inspector Signature:
Date:
,3 36 I1
Page 2 of 3 1 12128104 Continued

,j,
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes e No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate elow.
Yes
❑ No
❑ NA
❑ NE
ZscitAnalysis
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ N
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElY s
No
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
ElNA
ElNE
/No
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
E
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EI 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?
El Yes
//
B o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31, Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
,�
El NA
LI'N;2/
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q/Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1649 1 Departure Time: County: Alswy l__ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: C Title:
Onsite Representative: Q>7�6 JA ��% Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 =61 Longitude: 0 ° = d =
Design C*urrent
Swine Capacity Population
Design
Wet Poultry Capacity
fi
C`Urrent
Population
Design C►urrent
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
® Feeder to Finish
Dry Poultry
❑ Layers
❑Non -La Non -Layers
❑ Pullets
❑ Turke s
❑Turke Poults
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
El Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars
Other
Number of Structures;
❑ Other ❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes C1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes rJ �No
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: r] —3 ! Date of Inspection S z.
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure,/ Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �(eP 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3"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 D No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes QNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V 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 El Yes P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E 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
ETNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[�No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WN ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA
❑ NE
'Comments (refer to question#): Explain any YES.answers.and/or any: recoit Imendations°oreany,other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name _ (,[, ;. s - Phon 3IT
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128101 Continued

i
Acility Number: (4'j — Date of Inspection S`
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 El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes LI 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 InspectionVNo
Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fJ o El NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes yo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes WNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes L2 No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ Zo
❑ NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes L�J ❑ 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—d,/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes E 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 EJ*No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes NNo ❑ NA ❑ NE
❑ Yes L( No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Page 3 of 3 12128104

'Ill Eacility Number I it1 ICI _�4
Type of Visit O Ca pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 4 d Arrival Time: j 1 a Departure Time: County: OAI"h1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: S ICLAW..L
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =' E�j Longitude: = ° =' = "
Design Current
Design C►urrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Populafion
❑ can to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
❑ Pullets
❑ Turkeys
El Beef Feeder
❑ Beef Brood Co
❑ Boars
Other
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
[I NE
❑ Yes
[I No
❑Yes
EJN
El NA
El NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Conditued

Facility Number: — 9 Date of Inspection
"4�.Wastc 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: i.A&ZA)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [ No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes ZNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [?40' ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ILI 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 [2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes El"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
[ZNo ❑ 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 acre determination?❑ Yes❑
NA
[I NE
17. Does the facility lack adequate acreage for land application?
El Yes
;FN',o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
�Comritents (refer t queshan' #) `Ezplatn atiy YES'answers and/©nany recommendations or any other comments
.. rawtngs of factlrty to better explain sifuatrons. (use addrt�©nal
Used pages as necessary) w
L
er/Inspector Name �Jp - U Phone:erlInspector Signature: Date:
_.-.---------

Facility Number: 69 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IVo ❑ 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
❑ Yes .0 No ❑ NA ❑ NE
❑ Yes ❑D ❑ NA El NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L2 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L�J N
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
WVNIN
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LI No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ 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 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
El No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visitpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit TRoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: #l. d Arrival Time: O Departure Time: County: 04Go-! Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Q��A'�►�� S
Certified Operator:
Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = i = a Longitude: = ° = 6 = n
Design Current
Design Current
Design
C►urrent
Swine
Capty Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
® Feeder to Finish
'Zti t{i
306
❑Dai Heifer
❑ Farrow to Wean
Dr=y Poultray
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ I a ers
El Beef Stocker
El Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
Beef Brood Co
urkeys
10
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No.
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes WZNo ❑NA ❑NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 12128104 Continued

a
`N., 39
Facility Number: q — jo Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure j 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 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 dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental #tla eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C� 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?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E2 No ❑ NA ❑ NE
❑ Excessive Ponding []Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
_El
ld No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
[2(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Zo
❑ NA
❑ NE
,?fi� aBTAs� aE tJ LAGaaN ,SUMMAR-T SuEET WOO 37AR-tAdID STOP l.E✓Et-S .
i4fe-'M 6-r17" ;" tom uOg o'/ "Clzm -
?„6, Ar cr i�JF � ZXo t , rA,1t 9/6 3sV - 200 V
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: A to 69
Pnau 2 nF 4
IM8104 Continued

Facility Number: �� — 'j Date of Inspection G i+lo 0
Rd
h
fpuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EdNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check eyes ❑ No ❑ NA ❑ NE
the appropirate box. El❑[2" WUP Checklists Lp Design [I Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
ion ❑ Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers
❑ Waste ApWtocking
❑ Annual Certification
❑ Rainfall ❑ 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
Eg No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L!! No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑fYes
�No
[I NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
R Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�o
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
L/J 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
2f No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
/
}� , No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments -and/or: Dr'awrngs• ~� K
, ,..
Page 3 of 3 12128104

Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Qf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 `� d Arrival Time: ® Departure Time: County: 6AXI-Ajal- Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 15—TGAM L6 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c =1 Longitude: [= ° = 6
Design Currenf, Design Current, Desku� Curren#;;
Swine Capacity Population ' 'Wet Poultry Capacity Population Cattle Capaeity Population ':
❑Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -La er
[' Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other .
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ DaiEy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number.of 5tructuresY`:'� 4
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
111
❑ Yes [YNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El No El NA
El NE
❑ Yes
El Yes
'No El NA
❑ NE
❑ Yes
r�rN.❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA kf eJ
Spillway?:
Designed Freeboard (in): 210
Observed Freeboard (in): a3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dI ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑/ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes o ❑ NA ❑ N
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L'J No ❑ NA ❑ N
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ N
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 21 No ❑ NA [11,
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PI No ❑ NA ❑ ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [IHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or 10 Ibs ElTotal Phosphorus ElFailure to Incorporate Manure/Sludge into Bare Soil
ElOutside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
E
E
E
E
NE
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
[�o [I NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
E] Yes
YNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
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);
;lt.) uPDArt; 5'TOLKgA)G 916
Reviewer/Inspector Name �pn,1j�,C Phone: 319—
Reviewer/Inspector Signature: Date: 3 ar o`7
Page 2 of 3 12128104 Continued

Facility Number: 7 — Date of Inspection 3 g a
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ER, NNo El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3No ❑ NA ❑ NE
the appropriate box. ❑ WUp C] Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If es, check the a ro riate box below. Yes ❑ No ❑ NA ❑ NE
P g P Y PP P
[:]Waste Applica 'on ❑ Weekly Freeboard ❑ Waste Analysis ElSoil Analysis ElWaste Transfers ElAnnual Certification
El 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 O No ❑ 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?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
E,�l,< El NA
El NE
El Yes
El NA
El NE
ElL� Yes
,,L�No
'No ❑ NA
❑ NE
❑ Yes
ffNo ❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
❑'IQo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
C No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
CI No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number 3
(Division of Water Quality /
0 Division of Soil and Water Conservation V
0 Other Agency.
Type of Visit (?rCornpliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S ZZ Arrival Time: ® Departure Time: County: GIT U6fl) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: DE_W i'? A _S =u4Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
© Wean to Feeder
FeedFinish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
AD -Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = ° =
r.�
Design Current Design Current.:,
Capacity Population Wet Poultry Capacity.`Population Cattle x
Lj Non -Layer
000 —
Dry Poultry
i
i
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
U Dai 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 I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
❑ NE
❑ Yes
❑ No
ElYes
2 No
❑ NA
❑ NE
❑ Yes
9�No
❑ NA
❑ NE
12128104 Continued

F'icility Number: 1 — 9 Date of inspection S alv
Waste Collection & Treatment
:. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes U�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: (fit C aatiJ
Spillway?:
Designed Freeboard (in): 2-0
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Z No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
�,�
❑ Yes YNo
❑ 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? ElYes EN"ho ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes El"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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q N ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NF
❑ 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) lZ L k) s c o
13. Soil type(s) 'n Q QEC=q imu— '
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
ErNo
❑ NA
❑ NE
❑ NA
❑ NE
El NA
El NE
//No
ElNA
ElNE
VNo
❑ 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):
0 v P H A s uP 0 ATC-J2 A L�v v (P w 1:t44 G"f' q X1_-L)Ds. -?uq r Dare e_
5 L uoGr. oor1E . FF►A)vL , Anjv fZCCViRios LL60XC._ &000.
Reviewer/Inspector Name ! '� hi n' Phone: 7 96 - -7?.G J
Reviewer/Inspector Signature: Date: S� Z 4 fo
A..n.. 7 -r? 19/7rmA

I.Facility Number: — Date of Inspection S x 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA [INE
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 El Maps El Other ,.�
21. Does record keeping need improvement? 1f yes, check the appropriate box below. El Yes LI 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 InspectionZNo
Weather Code
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 04 ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No Cf NA
❑ NE
❑Yes
�El NA
El NE
❑Yes
VN9❑NA
El NE
❑ Yes
No ❑ NA
Cl NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2rNo
❑ NA
❑ NE
❑ Yes
Ep�o
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
EVo
❑ NA
❑ NE
❑ Yes
a.
❑ NA
❑ NE
Page 3 of 3 12128104

r
peof Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t]l v Arrival Time:
3 rJ Departure Time: County: ONSOd Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: `�' _ Title: Phone No:
Onsite Representative: W_A� 1Z[Ad (1.6-_ _ ____ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
a
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ 4 ❑ Longitude: = ° [� i ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
PO
La er
Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ,❑,, �NNo ❑ NA ❑ NE
El Yes M< ❑ NA ❑ NE
❑ Yes lJ No ❑ NA ❑ NE
12128104 Continued

_i
Facility Number: 14— ! Date of Inspection L !
Wa1 a Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E3No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I I j Structure 2 Structure 3 Structure 4
Identifier: LAb0N 1
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E 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 UrNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7No
N ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,,� El[I10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ LJ Yes No NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Croptype(s) i3Ey_my1A LfV S60
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
VEl NA
VElNA
❑ NA
Zo
ElNA
❑ NA
Aft. I�ee� 11pvATE� G�U� w.�T f Zon16 ArJD CvrLRf,l 0woD.J6
A4,5 c/f Ara7-4 SGo Spfz.a-( ='P6IJ'(56r-MA949
awrtl U_ -%_ 14A S 500 DE rJ YJ-IC_.0 wA L.L-S
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Name Lib 1-i )J Ja r<2 1 '. .:` � < A n d Phone�* 7` 9 - 71 G s
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑7Y, 2No ❑ NA ❑ NE
components of the CAWMP readily available? If yes, check
20. Does the facility fail to haVaWIUP
the appropirate box_
Yes
El No
El NA
❑ NE
❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
E2 Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wee y Freeboard ❑ Waste Analysis ❑ Soil Analysis ElWaste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking CropYield ❑ 120 Minute Inspections ❑ Monthly and V Rain
Inspections E]
Weather
Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CJ NNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ /No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
�NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El No
O NNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ON o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
G3 A
❑ NE
Other Issues
28. Were any additional problems noted which cause non .compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ffNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fait to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit
Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit:
Permitted E3 Certified 0 Conditionally Certified © Registered
9 Farm Name: ....!� ,lv
Owner Name: ...........F....... ! ..........................
MiningAddress:.._W......._...................._........._._._---------- -..-----_._._.
Time: 3=
Operational O Below Threshold
Date Last Operated or Above Threshold: - -.
County: � .c!SGpI.!� ....... _._ __._ ..._..._._._..
PhoneNo:.......... ........................................
Facility Contact: ................. ............................... Title: ..........'.......... Phone No:.............. - - ......................
Onsite Representative :%7-�/�r[ifC�^ Integrator
�,��il,R<_
Certified Operator: .._........ ........ _.,..... _............ __-- - � , ................ Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude • ° 49
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes XNo
❑ Yes )9 No
❑ Yes'xfNo
Structure 5
Identifier:
Freeboard (inches):
12112103
Continued

Facili Number: —�� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [I Yes ,21 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes )dNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings? 10
Waste ARWication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes XNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes)I'No
❑ Excessive Ponding ❑ PAN C] Hydiiaulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type � �'SFiPr1?L//�.4-1 R4V I . vAIA& / r.PA�ZiJ/I�Itl S
13. Do the receiving crops differ with those dt'signated in the Certified AnimaMaste Management Plan (CAWMP)? ❑ Yes JZ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes .2rNo
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 JETNo
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Odor ]-.sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes RfNo
liquid level of lagoon or storage pond with no agitation?
a+ 18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
19, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZI No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ONO
Air Quality representative immediately.
s-a
Commits (refer to question #) Explain any YES answers and/or anyrecommeadatrons or, any other comments. ,
_Use drawungsv of �cility to better explain situatEoas (ase addtronal pages as necessary} ❑ Fzeld Copy ❑Final Notes
e _.p
oRh = s�,9,g�zs� 7�rz vrz jm6lz a)-
r
A &'j19Ras
/5 6dE6 0 61)rR D [. /VkF-0 f U2 FOW4 n/ (1`RAsS F
�3 rA m a o o� FZ f_ G,4 5, 7 if,51,- O 5 460 �",ED �D A6& [��l
ice;
G J G(lA SYG ERG-ZC/9 TZd Ill eAWA1-r,.,4'0
V A6
r
ReviewerAnspector Name R K5-, —a7T t- W,
Reviewer/Inspector Signature: Date:
12112103 Continued

Fadl ty Number:61 — Date of Inspection
Required Records & Documents T ��
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes Q�No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? f
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes A No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
244. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes XNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
91
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
;dNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
(Z No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IP(No
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Additioital Commegts and/arDrawmgs
ZZ J# �1�PPtzcA-�Z�n� GC�0Noa4v �k sla &6 (,00A4�5b6,0 Zi
f+' I�Wr Z145
12112103

Facility Number Bate of Visit: x 43 Time: 1 3 = crO .
Not Operational Q Below Threshold
© Permitted [3 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: �Ewq K.2 �i l Gi +' [L �a �"^� County:yn f lot`'
Owner Name: pl eu'i' t ri C 5a' 1q Ce Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: De wg.4 s'1a 571 gywce integrator: �2u_ - oe l_1W-$/a-)n , I—L C
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude + ' " Longitude a 6
Design '` Current
Swine Ca aci P.o ulation
❑ Wean to Feeder
Design C+urrent Design Currettt
" P©nitry Ga aci P,o ulat'on Cattle Ca aci P,o ulation
❑ Layer I Dairy
❑ Feeder to Finish
❑ Non -Layer
1E3
❑ Non -Dairy
❑ Farrow to Wean
❑ Other
Total Design Capacity
Q. Total SSLW
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Li uid Waste Management System_
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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
Identifier: l
Freeboard (inches): 34
05103101
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �No
❑ Yes .21rNo
❑ Yes�N0
Structure 6
Continued

Facility Number: 6rJ — 3 9 Date of Inspection
S. 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 ADDlication
[:]Yes ONO
❑ Yes j2rNo
❑ Yes grNo
❑ Yes gNo
❑ Yes gNo
10. Are there any buffers that need maintenance/improvement? ❑ Yes P No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes IVNo
12. Crop type 63e ✓>J0� �i U a� $». ) rar`�,E +'� va Asa ��
B. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes R"No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes /11No
15. Does the receiving crop need improvement? ❑ Yes ❑'No
16. Is there a lack of adequate waste application equipment? ❑ Yes /)21No
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes J'No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes J6 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ANo
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ONO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes /'X No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
IZNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ONO
24.
Does facility require a follow-up visit by same agency?
❑ Yes ONO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes .,ZNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES�anssrers aniUoc any recommendahatis`.ot any other cou�ments.
Use drawings of facility to better explain situations. (use additional pages as necessary):' ❑ Field Copy ❑Final Notes
Tie
�f(,�E SIA :' qe hoccs�' Gt���, is #1
're well �� / 9tnal 4" 4 ee )'.I a aoA be_,-, iO4e, Cove," -
Reviewer/Inspector Name �.S-�o r, r�„s a, .T7�
Reviewer/Inspector Signature: Date: �2_ r?
05103101 Continued

Facility Number: b - 3 Date of Inspection 2 D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Pl�o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes FNo
roads, building structure, and/or public property) /
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �0
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 Z"Na
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JZNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings:
w
O5103101

Type of Visit lorcompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 12rRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facilitv Number Date or visit:
0 Permitted 0 C--eer�rtiifi-ed [3Conditionally Certified� - 0 Registered
Farm Name: LI�eWGi-y�t^Cie-_?'c'i`ti --
Owner Name eLt�at'1n �" MGe
Mailing Address:
Time: = $�
Date Last Operated or Above Threshold:
County: /)►i S1Otw _
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: r'
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 ° 0 « Longitude 0' 0 4
Wean to Feeder
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Subsurface Drains Present
No Liuuid Waste Manaeen
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 3� .
05103101
❑ Yes ;?rNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes')zrNo
❑ Yes ❑ No
❑ Yes 2fNo
Structure 6
Continued

Facility Number: 6f7— q Date of Inspection 3 2r! Q
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?
WastgApplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Pa Yai +1
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 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?
2I, 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 ReviewerlInspector 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 O�No
❑ Yes ONO
❑ Yes 2fNo
❑ Yes ' '1 o
❑ Yes ;dNo
❑ Yes dNo
❑ Yes ONO
❑ Yes ElNo
❑ Yes &No
❑ Yes XNo
❑ Yes Jallo
❑ Yes FerNo
❑ Yes ONO
❑ Yes JZNo
❑ Yes Ef No
jaYes ❑ No
❑ Yes eNo
❑ Yes ;2'No
❑ Yes .!J No
❑ Yes J'No
❑ Yes J�mo
❑ Yes ,EfNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments'(refer to question#}: Explay YES ai.isvtiers and/or any recommendations or au�p in anIher"comments. a t
`. a
4
'� ". ❑Field COPY ❑Final Notes
Use.drawin s of facile to better ex
g ty,
-, plain -situations (use additional6`pages as necessary)
1�l• /VQed -je ,fee MbrafQ rrert-,r4S WQL?kl �e svrd! 4e haVe IR
7WQ
wrs4e gn�tl s �ia-� wt` i•1 �iD c.�feYJ Iin, o;i emen1r,-
Anil
��eee fJ s.'r �o✓ ro•ti,e eafl " 2001 '- 1))"^. 'o"5 -
y 7 r ��
•! -� 11a o © - ad r, be-,e , -4-11e Per 6;1; 4Uf a n d 01 eO 0 ct• r'e
rye! -4l keO -
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: �%
O5103101 Continued

A
Facility Number: — 3 Date of Inspection
Odor Issues , r
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes O'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes .2rNo
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 -ZNo
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 ZFNo
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j2rNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orpDrawrngs:
$,r.�
05103101

ihnsron of Water Quality
Q:Dtvision of Soil and Water Conservation
-[ ,, __ _ ...: I.. - .., ..a ...; �_ _ `k ...- _ _ ...• .- .,.9-r - ...... - 4 4.� +.-. i ks.�.:.4�9.�,5?�d"#
Type of Visit )k Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ARoutine O Complaint O Follow up. O Emergency Notification O Other ❑ Denied Access
Facility Number �� gate of Visit: `d- g ab Time: 5 0 Printed on: 7/21/2000
EQ Not Operational Q Below Threshold
Permitted © Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: .......................
Farm Name: ........!'��.... "`�`-�Q County:..
1r'r"'{ ...............................................................
OwnerName:........................................................................................................................... Phone No:............-..-....................
Facility Contact:
Mailing Address:
Title:....
Phone No: _....
Onsite Representative: 0-1.............................................................................. Integrator: ....... 1..^��1r.�°ke ,
Certified Operator: ........ ................................................ Operator Certification Number: ..........................................
Location of Farm:
w
1
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� 0== Longitude �• �� ��j
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
Feeder to Finish JE1 Non -Layer I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JE1 Subsurface Drains Present I ❑ Lags•on Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed; was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State'? (if yes, notify DWQ) El Yes ❑ No
c. Ir discharge is observed. what is the estimated flow in gal/min"f
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 ,gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ; No
Structure I Structure 2 Structure Structure 4 Structure 5 Structurc 5
Identi bcr:........................................
Freeboard (inches): 3�
5100 Continued on back

1
` Facility Number: — Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plats? ❑ Yes 4 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 �qNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes jlg�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes k No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes JZ[No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ,kNo
12. Crop type
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 �1No
b) Does the facility need a wettable acre determination? ❑ Yes allo
c) This facility is pended for a wettable acre determination? ❑ Yes ff No
15, Does the receiving crop need improvement? XYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes tfNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Q'No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
J�j No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
IRfNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
i$'No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
MNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
E�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JVNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
0No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N No
:: Ko yi. . (igiis:or• di f cie..... ... noted• dii irid this:visit. - :Y:oi} wiii reeeiye �iti fprther. -. • : -
eorrespondeii& a�baut. this .visit.
Couurients (refer to question 40: Explain any YES answers and/or any recommendations or any comments -
Use dra of facility.to better ex lain.situations. use additional pages as necessary) _ --
�S ILL vim+
`L��-�F \ W�O��Qc\ \`• � �� �� t^'�Q., �C G �Q�-� s$\ � SG � L -W.S' � {-
Ic) �Q s�►,\� Ise s��� y. ((��
ReviewerAnspector Name
Reviewer/Inspector Signature: Date: r�—�'-Q 5/00

IFacility Number: — Date of Iiispection L 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 Wor hielow 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 gNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KNo
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 ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes +N No
rtAdditional : Comments:and/or
Drawings:
J
5100

Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit &Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number tfate«rvisit: G0 Tim®r: Printed on: 7/21/2000
Q Not Operational Q Below Threshold
*Permitted ❑ Certified 0 Conditionally Certified © Registered Date Last Operated or A ove Threshold:
.
Farm Name: ......DZ ....t' ........ 1�—E County: G
. �..............►... ........z...........................I................ ...... ...........................
Owner Name:
Facility Contact:
Mailing Address: ..................................................
Onsite Representative:.... G�-J �—
Certified Operator:
Location of Farm:
.... Phone No:
Title: ................................................................ Phone No:
Integrator:......... ......7..�..............................................
...................................................... Operator Certification Number:........................................
T
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude •
Design Current Design Current Design Current
Swine CapacitZ Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ FarroW to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lagtu�n Area ❑Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
10 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)
El Yes
❑ No
c. IF discharge is observed, what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system" (if yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
;;rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
IdentiFier ........................................................................................................................................................................................................................
Freeboard (inches): 3 1
5100
Continued
on back

lFacilily­Number:69— Date of Inspection Printed on. 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑Yes �<No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses.an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
/VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
PdNo
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
NrNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
JXNo
12. Crop type S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes 14No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
P(No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement'?
❑ Yes
9No
16. Is there a lack of adequate waste application equipment?
❑ Yes
lstN0
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
14fNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
)4 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ZNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
El Yes
� No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
violatigns:or def cJe"h' 6es were pbted dirrfrig this'visit: - V1. oir will 4-eeeive lio further
...........................
rorresporideh'e:abaut:thf ' isit' •.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.-.-.•.•.-.
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):
`? �sfk-�1�.-e z�-J
Reviewer/Inspector Name Qk
Reviewer/Inspector Signature: Date: l— 41--oa 5I00

.ti
Faci ity Number: Date of Inspection l=1Lt_Li_"JJ 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 it/or hrlow KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [$ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes qNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �TNo
,&1
5100

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number Operation is flagged for a wettable
Farm Name:_ acre determination due to failure of
On -Site Representati e: Part B eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name:
Date of site visit:
Date of most recent WUP:
Annual farm PAN deficit: � i �� pounds
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: 1. hard -hose traveler; 2. center -pivot system; 3. linear -move system;
(4)stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
fi. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigation operating parameter sheets, including map
/ depicting wettable acres, is complete and signed by an I or PE_
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11 - F1 F2 F3, before. completing computational table in Part 111).
PART 11. 75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required .because. operation fails one of the eligibility
requirements listed below:
_ F1 Lack of:acreage:whichresultedin:over-applicationmfwastewater(PAN) on:spray.
field(s) mccordingfofarm'slast two years:of-.T igation-Tecouis.-.
F2 Unclear, -illegible.- or lack of information/map.
F3 Obvious field -limitations -(numerous Aitches;failure:to-deduct Tequired:
buffer/setbackmcreaae;-or25%_ofiotai:acreageidentified=in CAWMP includes _ _
small ;-irregulady -shaped .fields = fields-lessthan-5.acres-fortravelers-or.lessthan
2 acres for. -stationary -sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III.

Revised April 20, 1999
Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP FIELD COMMENTS3
NUMBER NUMBER1,2 IRRIGATION ACRES ACRES %
SYSTEM
I I
I I I ! I I
k I I I I
I I I I ! I I
I I k
I I
I I I
I I I I ! I
k I I I I I I
FIELD NUMBER'- hydrant, pull, zone, or.point numbers may be used in place of tield numbers depending on GAWMP
and type of irrgation 'systern. - !f pulls, etc. cross rnorethan one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBERZ -must be dearly delineated on map.
COMMENTS! - back-up fields with GAWMP aci eage-exceeding=75% of its total -acres and having received less than 50%
of its annual PAN as'documented in the farm's previous -two years' (1997 & 1998) of irrigation Tecords, cannot serve'as the
sole basis for requiring a WA Determination. =Back-upfiieldsTnust*be noted in the -comment -section and must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
P1
Plan Jacks .following -information:.
P2 Plan -revision may:satisfy-75% rule based on adequate overall PAN deficit --and by
adjusting all field=acreage:to below 75% use rate _
P3 Other (ieAn process of installing new irrigation system):

© Division of Soml and Water conservation .. Operation Review
EI.Division of Sofl-and_Watee Corise_rvabon=Compliance;Insgection ,
Com Division of Water Quality w pliance Inspection _ r
•-. _ -rv. _
Other Agency - Operation„ Review
III Routine Q Complaint Q Follow-up of DW2 inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection ftd R
Time of Inspection I JjE,00 124 hr. (hh:mm)
Permitted [] Certified E3 Conditionally Certified [3 Registered 10 Not O erational Date Last Operated:
Farm Name: .......[ ..-
11 .`:^:�'.-��--......-..Y.. i.. �` ............................... County:........ . C..�-,?...
OwnerName:............................................................................--.--... Phone No.........................................................................................
Facility Contact: ................................................... ..................... Title: ................................................................ Phone No: ...........................
........................
MailingAddress: .......................................................................................................................................................................................................... ................. I ......
..
Onsite Representative: ,•��,¢ Integrator . t^� ..............................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
......................................................................................................................................................................................................................
Latitude • ° Longitude ' ` "
Design Current `
` _ _, Design , Gur�ent Design Current
:Capacity Population
_
ultyPCapacity Po 'tlabon_Swine
t
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer
_..
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
- ❑Other
_
❑ Farrow to Finish
Total Design Capacity
❑ Gilts,
--
=:
❑Boars
-- Total-SSLW
-: Number of Lagoons
❑ Subsurface Drains Present ❑ Lagoon Area D Spray Field Area
Holding.Ponds / Solid Traps
` ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? El Yes El 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 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L{
Freeboard(inches): ................................... ................................................................................................................................................................................
5. Are there any immediate threats to the integrity. of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 9No
seepage, etc.)
3/23/99 Continued on back

Facility Number- Date of Inspection 0
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes IKNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement? ❑ Yes [�rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes kNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes allo
12. Crop type
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
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
[1No
c) This facility is pended for a wettable acre determination?
❑ Yes
[�No
15.
Does the receiving crop need improvement?
❑ Yes
ONo
16.
Is there a lack of adequate waste application equipment?
El Yes
Xy No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
OU'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
I9. 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?
-yiolatfioris :or• delide,n ies -were noted• iltia'ing 4his'visit: • :Y:oir Will •reeeiye ;io further . .
correspondence. about this visit. . _
❑ Yes j$( No
❑ Yes ONo
❑ Yes NrNo
❑ Yes PrNo
❑ Yes I<No
❑ Yes No
❑ Yes' No
❑ Yes No
Comments.(i•efer`fo uestion # -E lain lilt YES�ansvrers and/or an recommendations or -an oiher_comments:
q �• y y f y
3se,drawings of -facility to betterTexplairi situations use additioniifpages as: necessary} ,
�s sc
3/23/99

'Facility Number: q — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail -to discharge attor below 9Yes ❑ 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 gNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes tffNo
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 M'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or e
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes P�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
Additional Comments and/or ravings:`
r11
3/23/99

0 Division of Soil and Water Conservation ❑ Other Agency w
Division of Water Quality Y
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection // Y
7 ,3
Tirne of Inspection b% 3 24 hr. (hh:mm)
® Registered M.erdfied 13 Applied for Permit [3 Permitted (] Not Oper—a-t-ional-I Date Last Operated:...,
Farm Name: ---- %...W..R..Y.N.....�a�nC� �a�rn-. .......................... County: ........ `s,� S.�ou�1.................................................
Owner Name ? ? n? ....��i..� . '.:°...:............. Phone No:.. q� °.....3:53 --V 9 6 d
.... .............................................................................................
i i I
Facility Contact: ............. ...... .... Title: .... Q.W..!J(, ............................. Phone No:
Mailing Address:..... �r3.... HR..+!!!s..... vr�?....!:i?................�T.4wNu./�c�.�..N...C... .........
...................................................... ..........................
Onsite Representative:... ..eL,�?.,,.'.,..c........ 51.1:re"'.`.ee .'............................. Integrator:...... MU 5PN!/........ ..........................................
Certified Operator; .... lk,.'A .AL........ . -�................... ...... Operator Certification Number ............ '
Location of Farm: 11AWX
.°t.... Jr✓Ille... . ..............7 ,6uJ5 uN �E.. ...GHQ .............. �
fq40.T.....c ..�'l 1 5....�Gra�s a de.... u... r!fz J��� ............ ? ? ...... .............. X....: .
f ' FA�i►9 a <<f- L ` Are/� r� on r 1,>
Latitude 10 —r 1.1 4-,:> 1' f l S I " Longitude 1 / / I- 1 3 / �J ` 103 1 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes (XNo
2. Is any discharge observed from any part of the operation? ❑ Yes RNo
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 galfmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
�No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
S. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
N(No
mai ntenancelimprovement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
[Wo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
7/2S/97

Facility Number:&'7 — ,39
! 8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes *No
Structures (Lauoons.Holdine fonds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure I Stricture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (It): ...
10. Is seepage observed from any of the structures? ❑ Yes 10 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
KNo
12.
Do any of the structures need maintenancelimprovement?
❑ Yes
XNo
(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 Ievel markers?
❑ Yes
kNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
ko
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ,rnu �dc_ 1 �- Cjl t t ��2r Secc I,UI t % -Q�...
....................... ......... ...........-.------....-- --------..............................................6
............... ...
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
O(No
18.
Does the receiving crop need improvement?
❑ Yes
IgNo
19.
Is there a lack of available waste application equipment?
❑ Yes
4�j No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
,4 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[�No
22.
Does record keeping need improvement?
❑ Yes
1;�,No
For Certified or Permitted Facilities Ont
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
E�No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
,dNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
�(No
o.violations°or. deficiencies. were-ntited- during this:visit.- You .win receive' no' ,tdrtherr .
c0re9pb6de O aliou.
E-thisvisit:• : ; : :.:. . : ,
lS . CjUA_ w(Hi T
�>
iVZO /77
urLc2 !zla;�
7/25/97
I Reviewer/Inspector Name
IReviewer/Inspector Signature:
Date:

[Routine OCompTaint 0 Follow-up of DWQ inspection O- Follow-up of DSWC review 00ther
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh.mm)
. Total Time (in fraction of hours
Farm Status, [I Registered [3 Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
a Certified 0 Permitted or Inspection (includes travel and processing)
[3 Not Operational Date Last Operated:
Farm Name- . . ...... ........ . ..... . ..... County:
Land Owner Name: . ..... Phone No: -41-ION-351-AAQ ....
Facility Conctact:
.... . .... Title: —.,6yAaV-n .... . .... --.— Phone No: . ......
Mailing Address: Run ..... . . W-1 ..... ....................... 6M jilt r Ijn. .... . ..... . ........ ...........
Onsite Representative: Integrator:
2�2 Certified Operator: Operator Certification Number:
Location of Farm:
Latitude 0 6 I rj " Longitude
Type of Operation and Design Capacity
Poultry; 5 . . . . . . . . . . . . .
. .........
ulati- Afapacitw.�VoDulatlon--
A
o ulation" 10try, -P I
Q Wean to Feeder Layer Dairy
&.,. Non -Layer I Feeder to Finish 0 2M ......... ...
❑ Non -Da'
Farrow to Wean
We
pacity..,:
Total�Mestgn� "a to Feeder Farrow
[[]Farrow to Finish ...........
7-7=
MEM
" MzWk-1 -
Number -of Lagoons, ifi pl;Vwngr i Subsurface Drains Present
WX❑Lagoon Area Spray Field Area
Gengral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at. [I Lagoon Ej Spray field El Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
[I Yes $9 No
[I Yes 50 No
El Yes E@ No
❑ Yes No
El Yes No
[I Yes P No
❑ Yes No
❑ Yes No
Continued on back

Facility Number: .... k7.._ —... ..._
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
50 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structurgs fLagoonsandjor Holding on
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Q No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
. �� ....... ...... . ..... .... .......... .... __.....
..............
10. Is seepage observed from any of the structures?
❑ Yes
IM No
It. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
R No
12. Do any of the structures need maintenance/improvement?
❑ Yes
EK 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 Ievel markers?
❑ Yes
Q No
Waste ADnlication
14.
Is there physical evidence of over application?
❑ Yes
ER No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ44 )
15.
Crop type
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Cff Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
0 No
18.
Does the receiving crop need improvement?
❑ Yes
18 No
19.
Is there a lack of available waste application equipment?
❑ Yes
14 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
G,NO
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
W No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
10 No
24.
Does record keeping need improvement?
❑ Yes
�§No
-COto'queshon'#)Ezpla�n°°any YES'answers'andlordny recommendabons'or any other comrnentss::
Use'drawin s of facile to better ez lain"situations. use additionai a es as neces's "` K '
L� 3i
IL Any csro�5 be p wit) ayeci On ska)d he i41ea4d In Out- c—AwAA
�� �,no�cr bvC�crS 54ticks t"hi bc. c re 0+ low Crean in 5�'a�l 9A.
a
r
Reviewer/Inspector Name _
Reviewer/Inspector Signature: _Z/ /A Date: r
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

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! Site Requires Immediate Attention:
Facility No. L22 -�_
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ' , 1995
Time: 4
Farm Name/Owner: DC"'A y^� S2t�w�cG
Mailing Address: 6'3 * YAW re(-W Ad, U/4 CCf Q.,VwcLl , AICf
County: ON S 40 dy
Integrator. __ j 4 0 Z P_N V _ _ _ — Phone:
On Site Representative: Phone: 3 S ` y76 6
Physical AddresVLocation: h R-W ; � . r eoM % „}s�,. ,�.�u,�;¢ u�. t l R� (sk
!r 25 C1njl &yj6 SK- 1105 (9U-0 Q.kd) G,�Z�ZM{14S `Fly-*, &, F4 . Lx segy,_
Type of Operation:
Design Capacity:
Swine Poultry Cattle
Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: jL,.-Sr Longitude: 7 % - Elevation: c�-P Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: 1 Ft. Inches
Was any seepage observed from the iagoon(s)? Yes 06 Was any erosion observed? Yes or&
Is adequate land available for spray? ewor No . Is the cover crop adequate? es r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellingsVGi or No
100 Feet from, Wells?09or No
Is' the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or t5
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orp If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spec acreage with cover crop)? Yes o
Additional Comments:
`T Y
Insp c oe r Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

P_j
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Site' Requires Immediate Attention:
Facility No. �9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO S SITE VISITATION RECORD
DATE: .1995
Time: l`
Farm Name/Owner:
Mailing Address:
County: !✓�1
Integrator:
On Site Representative:
Physical- Address/Locat
a-rc.
Phone: -
Phone: 3 . q
Type of Operation: Swine aa� - Poultry Cattle
Design Capacity: �4-D rAP Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ,3v' ' 97_" Longitude: % 19;?- " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have fficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche Yes No Actual Freeboard::O� Ft. Inches
Was any seepage observed from e lagoon(s)? Yes No as any'erosion observed? Ye or N
Is adequate land available for spray?� Yes or No Is the c er crop adequate? Yes or No
/�
Crop(s) being utilized: ``"! XeAW 5e A�-&
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es NO'
100 Feet from Wells 17es r 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 Mai 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 r N If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Si
0
cc: Facility Assessment Unit
Use Attachments if Needed.

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OPERATIONS BRANCH - WQ Fax:[phone] Jul 24 '95 11:15 P.13/1113
Site Requires Immediate Attention _ -V o
w
Facility Number: 9;77-3,f
SITE VISITATION RECORD
DATE: Suay y _ _, 1995 '
-s aj
Owner: u! ��' S�.c.a � _ Farm Name:
County: Kr� t,.h j
- 3 s
Agent Visiting Site: ,IV,,eJ _ _ Phone`
Operator: ..z, Phone: , jTf► 3s .1 3'7� o
On Site Representative:' A!!U —.n r--x- -r new wee Phone:
Physical Address: D•ri rF've JI �.�ss•,•rrCC w? T�I/cs++ or .r ry Fd+•t... IJ✓. go
AKr.* sr h'w r T4.s... Ash o.M +V.4✓ �tAr.. A1, iV.sr+. �t .2 �+ e.+1, rr
ivlailing Address:
J oc V ' a s
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 411yf_ Number of Animals on Site: e F/YP
Latitude: o �' _ _" Longitude: o �'
Type of inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot +8 inches) �Cep or No Actual Freeboard:._._ Feet . 0 Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes o a was there erosion of the dam?: Yes od-3)
Is adequate land available for land applications A�es r No Is the cover crop adequate? tr No
Additional Comments:
Fax to [phone]
Signatzre of