670048_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: z 4 Compliance Inspection (_) Operation Review (-) Structure Evaluation O 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 Timer County: Region: Wj�D
Farm Name: l `l�,sljn l l� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
i
Facility Contact: kDY�S �� 5 i Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 2 D
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultr.v
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
i
Dairy Heifer
arrow to Wean
w
Dry Cow
Farrow to Feeder
?Dr, P,oult ,
Ca ---I
Po ,
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I 113eef Feeder
Soars
Pullets
NJ
I Beef Brood Cow
Turkeys
Other1
TurkeyPoults
Other
I Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes KLl No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [:]No
❑ Yes jNo
o
❑ Yes
Yeso
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Faeili Number: III - 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 ❑ 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 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes X No ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 KNo
❑ 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
"'PLNo
❑ 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
P�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes XTo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Farili . Number: U I jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes {� No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes 79No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes A No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑No ANA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes XNo ❑ 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes K 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 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #) Explain anyYES answers and/or any additional recommendations or,any.other comments.
Use drawings of facility to better agFl_ a.m situations use additional pages as nec essary)
Iq �_ twd Do W r-H,4 co ferry','f )"'I'
lv'c" a -it 6f I G ('a*�) r-Pcdy_4 .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: W —70 —73 y r]
Date: 7
hi n
2 4/201

Type of Visit. 0 Co iance Inspection U Operation Review (� 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: Z Arrival Time: ® Departure Time: L County: Region:
Farm Name: a r -- 'S Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: cf_2rr.`5 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 2 4 �- Z- Z
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pap.
Design Current
Cattle Capacity Pop.
Dairy Cow
can to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ll , P,oult ,
Layers
Design
Ca aci
Current
Pao ,.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Boars
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes L2r< ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[? rNo
❑ NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: I L
Waste Collection & Treatment
4.•Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ 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 E2<o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ENO ❑ NA ❑ NE
waste management or closure plan? , T
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 ONo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P <No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ej NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rN ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
ZNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? rYes eNo
❑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 <o ❑ 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 No ❑ NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 4 jDate of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D-N'o ❑ NA ❑ NE
J
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EPIo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E3'gA— ❑ 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<o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes o
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Signature: z� /I Date: Ar
Page 3 of 3 21412015

►y
Reason for Visit: C-toutine 0 Complaint 0 FoUow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ / Arrival Time: ® Departure Time: 1 U—T-9-7 County: Or% o✓ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: (''`9�t i`S (1 c� 4l� Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design C•nrrent
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish ILayer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish �-kZ4
Design
D . P.oultr. Ca ac_i P,o
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
A
Turke s
Turkey Poults
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
do
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
BNo
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412014 Continued

acili Number: - Lcr I Date of Inspection: 2j S
/T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
°n 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
!__I 'moo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
0 Yes
[3-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[31�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
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L!d'' o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L1,
ff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[D4o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[7�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes t 04o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [DTo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections j
• ❑SludgeSurvey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L]❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

h*acili Number: - 4E Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes 8'1,To_ ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [;I -No- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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
E No
❑ NA
❑ NE
[—]Yes
No
❑ NA
❑ NE
❑ Yes
ITNo
❑ NA
❑ NE
❑ Yes [i]`No ❑ NA ❑ NE
❑ Yes [J No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes
No
[:]Yes
[ 0
❑ Yes
Q No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any:_YES answers andlor�any,-additional;reeommendations.or. anyother comments : w
Use drawings Hof facility to better explainp situatio n gns° (use addiht►nal:pages as necessary),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 's
21412014

Type of Visit: 0 20ouj
iance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
sit:Reason for Vitine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t Arrival Time:-l-F�-� Departure Time: County: OL-JeLXX) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: FyipbL.n�S�}�� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
C+attle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D. P,oult . Ca acity P,o
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lReef Brood Cow
Other.
Other
Turkeys
Turkey Poults
Other
DischarEes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes r�OO
o ❑ NA ❑ NE
❑ Yes NA ❑ NE
21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. 15+storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
r a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 Es No [] NA ❑ NE
[:]Yes nNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, 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 ❑ 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
VrNo 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 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
5/Vo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑YesNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
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
io ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[] Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6 o ;/ ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - C1 i2 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes /No
❑ NA ❑NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes Ea �0❑ 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 to ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes JeTNo ❑ NA ❑ NE
❑ 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
No ❑ NA ❑ NE
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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Pho#e:
Dater
�i4r� rl

Type of Visit: 0 Coi}{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: [%� S—� Departure Time: c — County: L)k6� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: makpzrs G&-z#,fz _ _ _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: o Oaf
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle C*apacity Pop.
Layer Dairy Cow
Wean to Feeder
I
INon-Layer I _E]
Calf
Feeder to Finish
—Dairy
Dairy Heifer
Design Current Cow
Di. Paul Ca pa P,o , Non-Dalry
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
I Other
Beef Brood Cow
Other
Other
NJ
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[--]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
��Oo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: 1021 - qg jDate of inspection:
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 21'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: "fir"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [7�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 17S No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes d No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes q 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
[D No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F2/N o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;KNo
❑ 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
[:2//No
❑ NA
❑ NE
Required Records & Documents
WNo
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
C3/No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
gdNo
[DNA
❑ 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
M 1`' '
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
Page 2 of 3
2/412011 Continued

Facili Number: jDate of Inspection: 3 In j
,24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �qo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes go
❑ 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 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)
No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [a
❑ NA ❑ NE
❑ Application Fieid ❑ 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/Impector 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 #1): 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).-.
�J�IZ1'o ?SEC;NT'LV g64- T. 111EE� IJEGJ (��I f60- ►kI 6t111Ei� , UPpi7f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C 1) — 00
Date: 13
2/4 oll

(Type of Visit: UCiance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: C Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: j v Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: S", jj MziCN (-A JL Integrator:
Certified Operator:
Phone:
Certification Number: `� M
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
Layer Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er Dairy Calf
Feeder to Finish
Dairy Heifer
Design Current D Cow
Di, l;oult , Ca a_ ci_ P,o Non -Dairy
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharp-es and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes o/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes �o
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: 617 - 41 R Date of Inspection: y -I 11 Z1
Waste CbIlection & 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: LAiW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ff 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
VNo
❑ 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 hreat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ayes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FI/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
I_J i10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
hio
❑ 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
No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �Zo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: L
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
U No ❑ NA ❑ NE
25 Js the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
C31No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
N ❑ 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
El Yes
�o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
WN
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesFNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
,.ommenrs treier co quesnon FFj r xpiarn any,rLb,answers;•anmor any aamnonar,recommenaanons.or-any;orner,:tomments ,,
Use drawirigs;of facility to,better' lam:situah©as (use eddrtronal pages as necessary.)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Jar��l 7 i��YY Phone t2b— 3 O 0
Date: 7i
/201

Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: QSRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O Departure Time: County:4K � Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: B&Cilr MMTC I-Aflk Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design
Swine C*apacity
Wean to Finish
C•urrenE
Pop.
Design Current
Wet PoultWD—acit-VIEPop. Cattle
La er I Dairy Cow
Design Current
Capacity Pap.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish Z
Dpt�
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design CEEI
urrent D Cow
D , P,oul_ . C:a aci P,o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke 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 0 NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes WVN
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: -_qj
I Date of Inspection: (,LJ6,
Waste Collection & Treatment
4. ls'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 Structure 5
Identifier: c� V_/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
waste management or closure plan?
`I
❑ Yes e No ❑ NA
❑ Yes dNo ❑ NA
�To ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en ronmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C!(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ]�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�J/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
[Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
YINt
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VJ�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6/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
WN o
❑ NA
❑ NE
the appropriate box.
[:] WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ I20 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 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - 4 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesFEI/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 10 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 ivo ❑ 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ONo ❑ NA ❑ NE
❑ Yes E:fNo ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
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
] o ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or;any other -comments w �
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone nj ra '6- 3K
Date: I +
Page 3 of 3 2/4/2011

to.
C<i
Type of Visit
Co liance 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: �T z'/� I Arrival Time: // j Departure Time: �� County: OML422 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: egANi7 yn's-lgEt ( _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: EJ O = 1= 4'
Longitude: EJ ° =' = «
Design Current Design
Current
Design
C*urrent
Swine Capacity Population Wet Poultry Capacity
Population
Cattle
Capacity
Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
Q
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets
❑ Beef Feeder
❑Beef Brood Go
❑ Boars
❑ Turkeys
Other
❑ Other1110
❑ Turkey Poults
Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
El Yes
7NNWo' ❑ NA
❑ NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection !(3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structture/ I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 61�SJ�/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EYNo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA
❑ NE
through a waste management or closure plan?
VNo
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
notify DWQ
environmentalth
Do any of the structures need maintenance or improvement?
[I7. Yes
ElElat,
NA
NE
7Nc
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,[/1
LJ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ET"No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ElNA
ElNE
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 W"
Use drawings of facility to better explain situations (use additional pages asneeessary}
Reviewer/Inspector Name l f'+ ; Phone:
Reviewer/Inspector Signature: ,,.� Date: / 6
Page 2 of 3
12128104

7717
Facility Number:70 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t<o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Xo
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑X
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
` "No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[21 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P i
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
51Ve
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
&Ko
❑ 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 p4o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P N
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
PrN.
❑ 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
,�
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
YNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Com 'ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: p Departure Time: County: 6AAlir;_i Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
ONE
Onsite Representative: J'�"Vc
Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 Longitude: 0 0 0 , = "
Design Gurrent Design Current
Swine Capacity PopulationWet Poultry Capacity Population
Cattle
Design
Capacity
Current
Population
❑ Wean to Finish
Wean to Feeder
10 Layer
❑ Dairy Cow
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Pouitty
Layers
❑ Non -Layers
on -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Po Its
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
❑ Gilts
❑ 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 El"No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El INN ❑NA
❑NE
❑Yes
❑ YesVNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Page 1 of 3 12178104 Continued

Fa!pity Number. ie'1 — Date of Inspection lR D
Waste Collection & Treatment ,(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
. �StructAur� I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): El"
No Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El 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 E3"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
ONo
❑ 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
ENo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
WNo
❑ 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
d ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
I:I o El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El YesVN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
,;_ a ` _ '-� ,_ _�
Comments {refer to c�pest on #) Ezplatn; anVl; SS nswers aod/or�any recommendations o 314 other comments
"
Use drawings;uf faciL� to,better�explaniAtuationnecessary)
Reviewer/Inspector Name 1 j ap AMU I Phone: bit 3 OP
Reviewer/Inspector Signature: Date: o
Pape 3 a 3 12128104 tonlinued

C
F cility 1Vumber. (,2 — 7 o I Date of Inspection 0
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 ❑ Checktists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings;
❑ Yes No ❑ NA ❑ NE
❑ Yes &3"No ❑ NA ❑ NE
❑ Yes
Oio
❑ NA
❑ NE
❑ Yes
,D<o
❑ NA
❑ NE
❑ Yes
Zll�o
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes L'fl/Vo [:INA ❑ NE
❑ Yes 2 r!o ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
❑ Yes ff"No ❑ NA ❑ NE
❑ Yes O"No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint O Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 147, $ Arrival Time: Departure Time: County: gY_jj 1n/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: e.AI✓• ZA — Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = i 0 « Longitude: [= ° [� l
Design Current
Design C•urreut
Design C►urrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
® Feeder to Finish f uL. l v
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
N
❑Non -La ers
❑ Beef Stocker
Gilts
❑ Beef Feeder
PO
Boars
El Pullets
❑ Beef Brood Co
❑ Turke s
Othe
❑ Other
:ey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
ElNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. !Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
II y��Structure I Structure 2 Structure 3 Structure 4
Identifier: LA
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f�7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 21Nro ❑ 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,St, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes �"N/o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P" 0 ❑ 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 7 ' 4 `� ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2rNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ado ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Q Ko
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[,—H<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
_ON"o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1VN
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes❑
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):
Wirth MLA •
Reviewer/Inspector Name o Phone: 0
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection 3 C
R!qquired 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. ❑ -,-,rT Tp ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes NeAnnual
❑ NA ❑ NE
❑ Waste Transfers Certification
❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Rainfall ❑ Stocking
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
yo ❑ 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
�1*o ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ Io ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
(3,NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
C��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
Elm
❑ 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
Ledo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or: D aivings: w
Page 3 of 3 12128104

Fa;ility Number (v 7 y
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of VisitC.,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: OO Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: GZk&r 'LT e- E U_ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = 6 = Longitude: [� ° =1
Design; Current. Design Current Design ;;Current
x Swtne- Capactty Population Wet.Poultry: ;Gapacity:.:Populatibn Cattle - ''Capacity Population'
ar
,,j ❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish j Z'L
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other Jh.
❑ Layers
❑ Non -Layers
❑ PulIets
❑ Turkeys
❑ Turkey Poults
❑ Other -
- - -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures T; '
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
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes O, Noo ❑ NA ❑ NE
El Yes ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
Wankell&llection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
eNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aq
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Lf o ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E�No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[3'No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
E] Yes
dNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo ❑ NA
❑ NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElYes
[3TNo ❑ 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
G No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
u Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
EY No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r s Goer r..0/0 b we_E p C p 7" L •
Reviewer/Inspector Name f Phone: /0 7
Reviewer/Inspector Signature: Date: '3 19r16
. _'S� .. J ... ......w ..-. ............�..

Facit teNumber: (,7 — 7 Date of Inspection
Re4uired 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 ❑ Desi gn ❑ Maps MO ther
❑ Yes �No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ RainfalI ❑ 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
fj�
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,VA
C No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ 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
E,Id''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
Doo
❑ 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
❑ NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
,Iio
O'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit CICoRoufiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: J t,Y/ Arrival Time: 0 Departure Time: C� County: dl� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: )AT L4AA1A16LQ
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = & Longitude: 0 ° 0 1
Design Current
Design C►urrent
Design Current
Swine C►apacity Population
Wet Poultry C►apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ Dairy Calf
® Feeder to Finish
I LXZq
I IZ-
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
other
❑ Other
❑Turke Poults
❑ Other I I
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man -,made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�El
NA
El NE
El Yes
7No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4.� Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
a
Structure 4
❑ Yes CJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [� N El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes ld N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo
❑ NA [I 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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,E2�/No ❑ NA ❑ NE
maintenance/improvement? ,.,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes 6dNo ❑ 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 ElEvidence of Wind Drift ❑ Application Outside of Area
sL
12. Crop type(s) � _ J G
13. Soil type(s) 1 k _ ,) �� I �� ✓L j� -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ es
®
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
OR
U No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
i _
❑ NA
El
17. Does the facility lack adequate acreage for land application?
El Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Po
❑ 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):
Reviewer/Inspector Name I a _Mj?4, (, I Phone: %D4 S
Reviewer/Inspector Signature: Date: 5 yr O1:
pntrn 7 "r 4 1 VIR/I}d !'nnfi"Piod

Facility Number: — Date of Inspection
Acquired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑1Qo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 040 ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LJdvo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
El
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
b<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,',�"o
L No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No [2 NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Dq<o ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D14o ❑ 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?
ElYes
G.<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
To ❑ 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
2 o ❑ 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

1
Type of V€sit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up O'Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: OS Arrival Time: I Z3v Departure Time: County: ON SLAW Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: Cf% AQk- GAy A 0AVG-#1 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
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 o =1 1 = Longitude: = ° = i a
Design Current Design Current
Capacity Population Wei Poultry Capacity Population
❑ Layer
hi ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey, Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Daia Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: E]
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 El No
El NA
❑NE
El Yes El No
❑NA
El NE
❑ NA
❑ NE
❑ Yes o
El Yes 7,Xo
El NA
❑ NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection :tl �fl bldS
oWaste 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
1. 1 I r
Identifier: AU2;w
Spillway?:
Designed Freeboard (in): 210
Observed Freeboard (in): 30
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
Zf 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) thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
LJ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes
�
2 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/improvement?
11. Is there evidence of incorrect 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 Area
12. Crop type(s) Leeff2.mun'ta ( (-}) sr, O
13. Soil type(s) V)rn F Lk `J►At_l,,=t,)&C
14. Do the receiving crops differ from those designated in the CAWW?
❑ Yes
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
do
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
Zo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
FNo
❑ NA
ElNE
18. is there a lack of properly operating waste application equipment?
ElYes
❑ NA
❑ NE
Commez~ts (refertto question,#) Egplgmiany,YES3answers and/or,,anysrecommendatronsr¢or any other comments:
Use drawrngs�oftfacrhty to better ex�ilam sit6ations (use addrtional pages;as necessary,):'
oi1,) Musr 06 sPsptcr of of t<Vr� i &JA(_i.S uzrH 17 OP— "rt£ P_A�Coj
090nTE G <w P '('MC t.D l wrt_nn- ,
Reviewer/Inspector Name 0 1J ' S°;; Phone:(L/0137S-
Reviewer/Inspector Signature: Date: V o,S
12128104 Continued

Facility Number: — ({ Date of Inspection ot�i
r
. to uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Zwo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Ch kf t ❑ Des' n ❑ Ma ❑ rift,
ec is s g P. er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
L9 Yes
❑ No
❑ NA
❑ NE
kly Freeboard El Waste Analysis ❑ Soil alysis El Waste Transfers
❑ Waste Application ❑ ZCropYield Xnthly
❑ ❑ ❑
El Annual Certification
Rainfall Stocking 120 Minute Inspections and I"
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
El Yes
EL:Jle>A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
A
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
WNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
A
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
WNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,.�
L7No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ul/'�O
❑ 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
O 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
[J40
❑ NA
Cl NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,�
L,d' c
❑ NA
El NE
33.
Does facilityrequire a follow-up visit by same agency?
El Yes
L'J No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

(Type of Visit JD Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit
Routine O Complaint O Fallow up O Emergency Notification O Other E3 Denied Access
Facility Number Date of Visit:
Permitted 0 Ce ed Conditionally Certified [3 Registered
Farm Name: ....._ ._ ......m� .._......_.
/
Owner Name:....._./.1l,t.......... ,rat y�� % ........ ...........
NI Lmling Address :............ ........ �e .1� .......... 6�.......... -
V
Not
Date Last Opera or Above Threshold: .........................
County:
Phoa No:_.............................................................. ._. �. .
Facility Contact: ........_._A4'<&*
--..._..._.... _ ... Title:.._....� ....Pone No: -
Onsite Representative:.... �%�!^1 ---------------. Integrator: ... {��1�
Certified Operator: .. . .......... . ............. . .... . ....... . ..... . . . . . . . ....... . .... . . . .............. . . ....... . . . Operator Certification Number:
Location of Farm:
7Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 Os9 Longitude • 4 44
-
-Current - , - DesYgu ' Current - Design
_ Gurreat
nDestgn ^ _
Swine k Ca dilation PoWtry g Ca ci Po Ca - Po matron
acrPo
:; uEaaon; ;Cattle w _.
t of Lagoons -
°
��Number
.
Wean to Feeder
=
Layer
�
[] Dai
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes E 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?
❑ Yes [I No
❑ Yes � No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ?No
Waste Cotlection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway ❑ Yes j�No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... .......................... .......................... ........... -............................. ... ...........
Freeboard (inches):
12/12/03 Continued

t
Facility Number �� — Date of Inspection .1/Ll�L7J1
1.
5. Are there any immediate threats to the integrity of any of the structures observed? (ire/ 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 ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 0No
8. Does any part of the waste management system other than waste structures require maintenance./improvement? ❑ Yes A No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes j�NO
elevation markings? /
Waste Application
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 j No
❑ Excessive Ponding ❑ PAN OTydraulc Overload ❑ Frozen Ground ❑ C mr and/or Zi
12. Crop type V
13. Do the receiving crops differ with se desi�sltA in the Certified Animal Waste Management Plan (C )?
❑ Yes No
14. a) Does the facility lack adequate acreage for land application?
❑ YesNo
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?
❑ No
I6. Is there a lack of adequate waste application equipment?
/R'Yes
❑ Yes JdNo
r
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes Aj No
liquid level of lagoon or storage pond with no agitation?
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 gNo
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.
Comments prefer to queshon'f#) Ezplarn any YES'asess awandior any recommendations -or any omen comments. x
;Use drawings of iscihty to better explain s1tira ; {ase adti�tuinal pages as necessary}.� ❑ Feld COPY ❑Final Note
zP
yG 1[ Po
/Uo iers'
3 l
Reviewer/InspectorName r =x ^ y a r x v n
w.
Reviewer/Inspector Signature: Date: y2
12112103 f 1 1 Continued

Fa ty Number:/ Date of Inspection Z D
Required Records`& Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
,ETYes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes 4KNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes )z No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis 10 Soil Sampling
24. 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 ,I No
26. FaiI to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes No
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes No
28. Does facility require a follow-up visit by same agency?
[]'Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes j2rNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form [:)Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
u /O �S.E �,c�/Ji4•S7� �TNr9-GS�S �•'�iP Z5
c.AFO)
12112103

Type of Visit ocompliance Inspection Q Operation Review O Lagoon Evaluation I
Reason for Visit 0 Routine Q Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit-
[3 Permitted 0 Certified 0 Conditionally Certified 0 Registered
Farm Name: a -6 G Fc-" "'-%-
Owner Name: k4e,,Ce - C,,,V(3 AvjL.
Mailing Address:
Facility Contact- Title:
Onsite Representative:
Certified Operator:
Location of Farm:
`Z O Time: 1 3
IQ Not Operational J2 Below Threshold
Date Last Operated or Above Threshold:
County: QINtr e t J
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude ' 6
Design Current
Design Curren
Design Current
Swine Ca aei P,o elation
Plouitry Ca aci Po elation - Ca aci P,o elation
❑ Wean to Feeder
❑ La er
0 Da
Da'
❑ Feeder to Finish
❑Non -La er
I J0Non-Dairy1___1
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design C*opacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
❑ Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area
Holding Ponds / Solid Traps �
❑ No Liquid Waste Management S stem
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? ❑ Spiitway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Freeboard (inches): 2 4-
05/03/01
❑ Yes14No
❑ Yes ❑ No
❑ Yes ❑ No
[I Yes ❑ No
❑ Yes 2]'No
❑ Yes ZNo
❑ Yes 6No
Structure 6
Continued

IF
Facility Number: (o? -4i2 Date of Inspection 0 3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONO
(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 _j2"No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ZNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 2!fNo
12. Crop type -9e r w, v ct c1 �s, `) j 5a. A if e,- re, + ,,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes .ETNO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 4!1'No
b) Does the facility need a wettable acre determination? ❑ Yes ,B'No
c) This facility is pended for a wettable acre determination? ❑ Yes i,E{No
15.
Does the receiving crop need improvement?
❑ Yes ,EI-No
16.
Is there a lack of adequate waste application equipment?
❑ Yes ONO
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ZNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ,❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ONO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes '"No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes 0No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ff No
24.
Does facility require a follow-up visit by same agency?
❑ Yes )6No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )Z1'No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy i._I Final Notes
TL t -ee c i rd s
ke p4 . -Ti, � 9-VW e 110 L- sC l I. o, - 01 S p 4d&% Ave
The Y� f c, S 0 d Of S r—%�A r f �'i r Gt , +^� C ,r fy !"1 ✓ . c..I- c4 v C 1/7" U j L
k, e I. Z o ►n c s�G; r G � r K Y�i "l C � pf ✓t!�
f r
Ur%Gik,,s U re%4%P r S?r ri S'o Of- l e la`
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 2/. /0 3
05103101 Continued

Facilitv Number: 0 -- t13 Date of Inspection Q6 m
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
�jtn,nk ypE�% 140;r ! d'4r eAr,,)�+r•
05103101
❑ Yes ❑ No
❑ Yes xr'No
0 Yes 07No
❑ Yes 'No
❑ Yes �No
❑ Yes ❑ No

Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit �-eKRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number y Date of visit: d Z Time: 1 l S
10 Not O erational 5 Below Threshold
©Permitted ©Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: �� r -- - _ County: �y1 S o[•✓
Owner Name: liGl ✓enqyij 1i
Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: / Q_y-e„�lr �� t% P+�l G` U61 -_ Integrator: f p Certified
am-
Certified Operator: ! Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 0 K Longitude 0' 01 0
Design w Current Design ,.Current W Design - Current
Svrtne Ca actri _. Po ulstron 1?ault -_. Ca iicrty -Po ulation =Cattle_.. Ca aratv.Po iilatxon r
❑ Wean to Feeder ; El La er Da' 1
❑ Feeder to Finish ` ❑ Non -La er =PD Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Ueslgn CaP act
❑ Gilts
❑Boars Total SSLW
- =
Number of Lagoons` ❑ Subsurface Drains Present ❑ Lagoon Area ❑ spray Field Area
.7
llotding Paads l 5ohd':Traps _ ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes,,ffNo
Discharge originated at: ❑ Laaoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El 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 gallrnin?
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_'2'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes) No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches): -2
05103101 Continued

Facility Number: &7 —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?,
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ]])) El Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 1 P r"'+ VV d c- H-, V , 5wt o,. l % �/'a„► '7
13. Do the receiving crops differ with those desi6nated 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. 1s 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/lnspector 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 �No
[:]Yes _No
❑ Yes J&No
0Yes ❑ No
❑ Yes ,No
❑ Yes ,ETNo
❑ Yes Z'No
❑ Yes 9No
❑ Yes �No
❑ Yes ZNo
❑ Yes j2rNo
,Yes ❑ No
❑ Yes �f No
❑ Yes _'2'50
❑ Yes,,E:rNo
Oyes ❑ No
❑ Yes 2No
❑ Yes_,ErNo
[:]Yes _PErNo
❑ Yes 2rNo
❑ Yes . "No
❑ Yes 2rNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
C ipiain any YES atm ers�and/or--any recommendations or anv outer comments
q 3
(seof
_
Use drawl fariiru�to.better,ea lain situations: (useaddtttonal a es;as aeressa `. L � R_
_ _ _ � tY� n P . _ P g r'Y) � ❑ Field Conv ❑Final Notes7.
p. "e so c Dke -rn)1d SeT r;serJ aleL;+C (jean -1 ► sy. 4ar"\ �ei•i5
I•-V�
4z,v'ned a/r. Mom. egveyLgv9 Li* ;►'1'0b'C'1+Cd �h�l� f ' he je-H;►Vj
CUa a4�c velJvef 4a l'-/p elim:►74-1-e A"s �►^Bb�e•n
ro0V1�iP7vC0
Reviewer/Inspector Name rS
Reviewer/Inspector Signature: Date: 2 Z
O5103101 Continued

• Facility number: 6 7 Date of Inspection 2 4Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours? ❑ Yes K-110
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J2'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
orb roken fan blade(s), inoperable shutters. etc.) ❑Yes,�o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 2TVo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional,Comments and/or'Drawings--
��.or.g5 rj c,Ave no+ �e 6ee--k Se,'S'9ed% 411e� neap( y
-fie b c s� r � 5 �e dt i �-► /►'I c; rG lr, P / /�P f ,` i 2 a � 3 .
-T'i,e 6eemOde) car ih
zonesct �
►q
InSCme nee& _ M�. A k
QG36 &q 6 V Li'-v T11e,--e�
a+'�'ecEJ ��� ot� JEt,✓ A•1d�o�a'Ji �/Q-te►� • -�h@se .S eGi $t;'
h 1�►
4 ilea
p1s6;
� ? 1_5 we4 'PIWAse c�Q4 - eeArl > cal ass 1's���ce
n rc,q sa Aq appt<<-a�►`may.
) S
ly. Tie svee -10 4ave
6a d� ys air ��� 1 taai��. ✓c�-�s Aid e .fvc It avl'?l f; s
-/o G ti l c v lode d'k e yl9 e r► nt�°/d 1' e:,d -133 e -T r< e /-f
r" e ee 7�1' 'qt}'p ears ilo
} be na An �1 �or�`r >Ca ✓ �
1/9 v'<4 -��tr pl,c,G}� �'C.TODC'.✓ ZQO! q ! �'L�t�rO►�-
_1
05103101

V1S1Un Of
`� Q_Div4sion of it an -Water Conservateon _ a�
Type of Visit ACompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: I 1--i q 5 1 Printed oh: 7/21/2000
NNot Operational Q Below Threshold
Permitted [3 Certified (3 Conditionally Certified 0 Registered Date Last Operatedor
Above Threshold: ........................
Farm Name ' '" VC-Q1-� L /�—" 1r��...�� �C� County: _ '?.`....................................... ......................
.....................................I..... ............... ..:..._,__. _...._.............
Owner Name:.. .................................................
Facility Contact:.............................................................................. Title:
MailingAddress: ........................... ..............................................................
Onsite Representative: 0�................................................................
Certified Operator:
Location of Farm:
Phone No:
Phone No:
I............................................................__...._....._..._..... ........
Integrator:.,_--.-!, `"'�
.............. ............................
Operator Certification Number: .......... ..............
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� Longitude �• �' �
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ILI 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 ❑ Lag-,nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste ylanagement 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 discharec is observed_ what is the cstirnaicd I'low in gal/min?
d. Does discharge bypass a lagoon system' (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 4 No
❑ Yes 0 No
❑ Yes VNo
Structure 6
Identifier: .....................
Freeboard (inches): 3S
5100
Continued on back

1ta
Facility Number: (rl — Lile 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 plan? ❑ Yes UNo
(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 UNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes kNo
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes D(No
11. Is there eviden a of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes D4No
I2. Crop type -"J_S:� , off+—�R" G Veep �d
• f
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yWhti$iis:oi- defele 6bg were hated d&ihd this:visit: - Y:oit will-teeeiye Rio futthgr.
�tiriesporicYeiRce: about this :visit. :::
❑ Yes 12fNo
❑ Yes brNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes N(No
❑ Yes XNo
❑ Yes XNo
❑ Yes KNo
V Yes ❑ No
❑ Yes No
❑ Yes W No
❑ Yes t<No
❑ Yes tRrNo
❑ Yes ONo
❑ Yes t�No
Com lie its :(refer to question #): Explain any YES'answers and/or any.recommendahY
recommendations or an other comments: - --
Use mdrawin s of facili to better explain situations. use.additiodal a es as necessa `
g ty p . ( P g.r . ry -
��1 G��..�- ���. �- ����w �.��� �.. �� (� �,� �, �-�.�- •-ems-� ���VNK
Reviewer/Inspector Name 1l^
Reviewer/Inspector Signature: �` Date: 5100

Facility Number: 9 _4431Date of Inspection IJf•�_4� LJ Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below krYes ❑ 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 FNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;4 No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ANo
r
5100
J

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number
Farm Name: C e,<- vL
On -Site Representative:_. C.
Inspector/Reviewer's Name:
Date of site visit:_''
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility item(s) ' F1; F2 F3 F4
Operation not required to secure WA
determination at this time based on
emption El E2, E3 E4
Date of most recent WUP: , —9,9�)6o Operation pended for wettable acre _
tt determination based on P1 P2
Annual farm PAN deficit: 1�5 pounds
Irrigation System(s) - circle #: '1'. hard -hose traveler,, 2_.center_pivot system; 3. linear -move system; .
stationary sprinkler system w/pemnanent pipe; b. stationary sprinkler system w/portable pipe;
stationary gun system w/permanent pipe; 7. stationary gun system wlportable pipe
PART I. 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 D2M3 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 111. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist'in Part II. Complete eligibility
checklist, Part it - 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 ofthe eligibility
requirements listedbelow:
_ F1 Lack.of:acreage_whichTesuliedin:overs2pplicafion-zf_wastewater_(PAN) onzpray_
fields) :accordingdofarm'sdasttwoyeasmfirrigabon-xecords.-:
_ F2 Unclear; illegible,�or lack of information/map:
F3 Obviousfield-limitations Inumerous:ditches;failureio-_deduct required..._.
buffer1setback:acreage;mr25%:of#otal acreageddentifieddri_CAWMP includes _
small; irreguladyshaped fields-�fields:less-than -5-acresfortravelers-oriessrthan
2 acresfor.-stationarysprinklers).
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 111.

Revised April 20, 1999
Facility Number
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS3
NUMBER
NUMBEW-2
IRRIGATION
ACRES
ACRES
%
I
SYSTEM
FIELD NUMBER'- hydrant, pull,zone, or:point numbers may -be useb in place of tieicl numbers depending on CAWMP
and type of irrigation -system._ If pulls, etc. crossmore-than 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 NUMBER2 - must be clearly delineated on -map.
COMMENTS' - back-up yields with CAWMP acreage_exceeding75% of its total:acresand having7eceived less.than 50%
of its annual PAN as documented in the farm'sprevious-two years' (1997 & .199B) of irrigabonTecords,-cannot serve -as -the
sole basis -for -requiring a WA Determination.:.Back-upfieldsmust-benoted in the-commentsectionand must be accessible
by irrigation system.
Part IV. Pending WA'Determinations-
Pi Plan lacks -.following information:
P2 Plan -revision -may:sabsfy-75% rule based on adequate overall PAN deficit and by
adjusting -all field -acreage--to -below 75% use rate
AP3 Other (telin pro Ts of instRIling new irrigation system):_

r Gj_ nfSoilndaterCosr`U°RDmsJon oWview
_
r � ;Drvisron of Soil andLWater`,Conservation Compliance L specbon ; "
tDrvislOfl of Water t2ual�ty :Compliance Inspection
Other°eac
� y W -. p
� - O erahvn Review
Routine 0 Complaint 0 Follow-upof DWQinspection 0 Follow-upof DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted [] Certified 0 Conditionally Certified 0 Registered 113 Not Operational Date ast Operated:
Farm Name: lO 1f_1.. ....................................... County: ------- 0-...... ..`:.Ln4...............................................
Owner Name:
Phone No:
Facility Contact: .. Title: .. Phone No:
Mailing Address: ........................ ..............
-.......
Onsite Representative:...._ .'`I-QY.........................._.........................-..........-. Integrator: �'1'' ..................
Certified Operator:......, ............................................................. Operator Certification Number:
Location of Farm: `
Latitude • 6 r--�44 Longitude 0 6 «
=:Dena Current'. Design Curreni" _Dest
r . _. 1 _ Current
r;, - CSwne Poultry ttlpacty Patyti_.tion
❑ Wean to Feeder ❑Layer ❑ Dairy
R:
Feeder to Finish ❑ Non -Layer ` ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other :.
❑ Farrow to Finish Total ]36ign.'Capacity :;;
❑ Gilts
❑ Boars :Total`SSLW'`
Number of:Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System i
vi y.-
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? (Ifycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �No
❑ Yes *0
❑ Yes P(No
Structure 6
Identifier: yy��
Freeboard (inches): .....--.....0
.................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes dNo
seepage, etc.)
3/23/99 Continued on hark

FaCility Number: — b° Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence f over application? ❑ Excessive Ponding ❑ PAN
12. Crop type 1 SGj
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Nd-' iMhtidtis:oe. Wide a.es were hofgd 00ing �bis:visit; - Yoft will -receive Rio further - : -
corres�andeh& about thLVisit..................
❑ Yes [(No
❑ Yes [)(No
[-]Yes WNo
❑ Yes (No
❑ Yes Wo
❑ Yes gNo
❑ Yes J!j h�o
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ,KNo
❑ Yes KNo
❑ Yes ONO
❑ Yes &o
❑ Yes XNo
❑ Yes gNo
❑ Yes YNo
❑ Yes j9No
❑ Yes ONO
❑ Yes ['No
[]Yes ONO
Comments (refer to question #) Explain -any YES;answ'ers'and/or any recomiiiendatious or-anyotler cominents
Use drawings of facility to better explain sitnadons {use.addttioital_pages as necessary)
.. _ p_ -..
G� + Ire C�+-� 5 Cla t-2 d �,G�-. •
�--e t►�y 4 a`� SeRl L9 %zS\ _V 44 �- ►�
i Reviewer/Inspector Name r z
I
Reviewer/Inspector Signature: Date: qr I (--a

• " 0•Divisioirrof Soil and Wafer Conservation -Operation Review
r ©Division of Soil and Water Conservation -Compliance Inspection
-
WDivision of Water Quality- Compliance Inspection
Cl Other.Agency - Operation Review -
lRkRoutine 0 Com taint 0 Follow-u p of I)WQ inspection 0 Follo,, -ti of DSWC review 0 Other
Facility Number Date of Inspection
'i'irne of Inspection j Q 24 hr. (hh:mm)
0 Permitted [,Certified 0 Conditionally Certified © Registered 0 Not Operational Date Last Operated:
Farin Nantes .../ TC G�✓6`� Cannty OJ
4 .a...................................................................................................... ... .. ..................-.......-..-.............-......................-.....
Owner Name: -.-I. `.` !� �r `LC'!^ � .. Phone No:.....
Facility Contact:.............................................................................. Title:
MailingAddress: ..........................................................................................
Onsite Representative: ,6W'^ ...
Certified Operator:..........
Location of Farm: .
.............. Phone No:..........
Integrator:......In
...............
Operator Certification Number: ..........................................
e .......................... ..........
....-.....................�........-►...�s....-•.....-.....-.......5.......................................................a ... ti. ,, s
.............................................................................................................................................................
Latitude Longitude 0 < i6
Current
awme
❑ Wean to Feeder
Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-tnadc7 ❑ Yes ❑ No
h. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ❑ No
c. If dischartTe is observed. what is the estimated flow in galltnin')
d. Does discharge bypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9No
3. Were there any adverse impacts to the waters of the State other than froTn a discharge? ❑ Yes (No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes VNo
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: r�Q
Freeboard(inches) ............ ...J............... ................. ..-................ ................................... ............... .................. ....... ................................ ....................................
1/6/99 Continued on back

Facility Number: Oj — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes P(No
(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? El Yes a No
S. Does any pact of the waste management system other than waste structures require maintenance/improvement? El Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes " No
Waste Aonlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes C�fNo
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes VNo
1� ��
12. Crop type.....!�...................�.��............................................................................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? [:]Yes KNo
Cr
14. Does the facility lack wettable acreage for land application'? (footprint) ❑ Yes dNo
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
0: N:o.violatlons.or. deficiencies .were noted. daring Ais.vi5it.. Yoti wili.rerceive nor.further.:.:
• : • eorresporideitee; about; this visit.:
Comments (refeir to question#): Explain any YES answers and/or any recommendations Or any other comments .:
Use.drawin s_'d facili ..' better ex lain situations. use additional a es as necess
g tY ro p ( p g ary)
�dct) Re z-� err, Rey v 90
❑ Yes RNo
❑ Yes XNo
❑ Yes KNo
❑ Yes Wo
❑ Yes S(No
❑ Yes XNo
❑ Yes C(No
❑ Yes WNo
❑ Yes ® No
❑ Yes fgNo
co a—Y.5 + Al-le—lo— <3 vef ,4 • �t^lj� >21p1_� iQ
be_ w Le
, 91D 10 V,4, OQWC�,L_e5l IV
Reviewer/Inspector Name `1pti
Reviewer/Inspector Signature:
Date: 11/6/99

Name of FarmlFacility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream SIope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report
U� _rZ fj,- 17
� Names of Inspectors
y„
Freeboard, Feet
Z 5 Top Width, Feet
J - - Downstream Slope, xH:1V _ 7401
Yes_ No
Yes No
Erosion? Yes / ♦ No
(Check One, Describe if Yes)
Condition of
C1,Q
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes x No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments
®E

[3 Division of Soil and Water Conservation ❑ Other Agency
'Division of Water Quality
IGLRoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection ZZ
Facility Number Time of Inspection '/ 24 hr. (hh:mm)
U Registered ;Certified 0 Applied for Permit © Permitted JONotOperational I Date Last Operated:
Farm Name: r7la%.!�5 .............................. County:........... lO-
S
Owner Name:..../ - ..... CAv<r 4C9 a Phone No:.............2��.................................
...............................................Z
Facility Contact: .....4. Title: Oe" h il — ...... Phone No:
MailingAddress: ............ ..---.--- ...............................................4.............................. ......I.. ........................................................... ....................
kb-
Onsite Representative...... .. C. :..... .... Integrator: ..... %SAP. l f ..
Certified Operator;.... ........ .................. Operator Certification Number......................
Location of Farm:
I i i i i lliiii ii �= = = = C
C
Latitude =' 0' =" Longitude =• 0' =" .
DesignA Current a
�Svv�ne
Design Current I.IDestgn Current
Copacrty Population Poultry
Capaciityf Population' Cattle: ' Capacrty'Populhon
❑Wean to Feeder
❑ Layer
❑Dairy
Feeder to Finish
I❑ Non -Layer
JE1 Non -Dairy
I='
❑ Farrow to Wean
Other
NE
❑ Farrow to Feeder
110
❑ Farrow to Finish
Total Des>tgn Capacity
r
❑ Gilts
[I Boars
,
"` Total`SSLW
Number of Lagoons
/ Holding Ponds ©
❑Subsurface Drains Present
❑Lagoon Area ❑Spray Field Area
❑ No Liquid Waste Management System
F r
General
1.
Are there any buffers that need maintenanpe/improvement?
❑ Yes
E�No
2.
Is any discharge observed from any part of the operation?
❑ Yes
ER -No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
.KNo
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
❑ Yes
Sallo
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
J'No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
i2 No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
14 No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
®,Yes
❑ No
mai ntenancelimprove ment?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
P No
7/25/97

Fa-Itity Number
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.i-Ioldin Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ..........�Tb.�4�...,...
10. Is seepage observed from any of the structures`?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) -
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or noff entering waters of the State, notify DWQ)
15. Crop type...........4.3 ...............................7.............................. r... .................... ---...................
❑ Yes
Q(No
❑ Yes
IffNo
Structure 5 Structure 6
❑ Yes
[2 No
y] YU
'
No
Yes
❑ No
❑ Yes
L3 No
❑ Yes KNo
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
qNo
❑ Yes
J'No
❑ Yes
QNo
❑ Yes
V No
❑ Yes
JkNo
❑ Yes
&[No
❑ Yes
No
❑ Yes
No
Yes
❑ No
0-No.vioiations-or' deficiencies.were,noted-during this:visit.• You:will ikei ive,'no,f4rttier- : -
: co&T ponde to dho4t -this:visit:- :
/Z. Ahr- //f gas ' Gv'r .Ct p�►,�� J _ /H �,��2 f,2as�;
-A ev,.,o c(
/Lzv f/, S ZcC_.,•,/ /Cum; -� �rJ A voii7 Pd55. 64 ;�,kRZ.
7/25/97
I Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: /t7/ZZ

140 Routine 0 Complaint 0 Follow-up of DWQ inseection 0 Follow-ug of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh-mm)
Total Time (in fraction of hours
Farm Status- []Registered (:]Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
Certified [I Permitted or Inspection (includes travel and processing)
❑ Not Operational Date Last Operated . ....
Farm Name:
Land Owner Name:................ Phone No: ...... . .....
dD
Facility Conctact: .... t�!A.�RLJ ...... . ..... ....... . .. Title: 6 Phone No: . .......
Mailing ly Address: .... . .... ............ ..........
Onsite Representative: .-EquDi" 40 IVA Z-D Integrator:
Certified Operator: ....... 0.Operator Certification Number: .... . ...... ..
Location of Farm:
..i:Z i Z . .... J.X�. v .S- . ...
-
Latitude Longitude �V Ike. tv'k-L—e vw% le­rf-, j
TvDe of Oneration and Desien Capacity
. Mai
z
_W: e Current&PIM
t
MEM-5
Swine Ca I lition. *0 UILIMIM-i'o n7
❑ canto ceder
[3 Dairy
0-Feeder to Finish Non -La er El Non Da
W!
Farrow to Wean 9
Fan -ow to Feeder TotI'VesigW29- .apa. I
nl - —
n,
Farrow to Finish
Mkm
er
..... ...... ............
Number ofE"
ce Drains Present
mAS4aldi F 0 Subsurfa
M
Lagoon Area U,
Spray Field
Geneol
I . Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon 0 Spray field 0 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 maintenance6mprovement?
0 Yes SNo
11 Yes. [}No
0 Yes 13-No
0 Yes 131TO
0 yes
Brqo
0 yes
ONO
0 Yes
BNo
[Tyes;
E] No
Continued on' back
2-o ,

l
Facility Number: .,yj ...... . .....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes C o
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure l Structure 2 Structure 3
2•�
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-I2 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
❑ Yes Ca o
❑ Yes R-Ko
❑ Yes M -No
Structure 5 Structure 6
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste -Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. P type—. -..........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a Iack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes Ey'glo
❑ Yes Elo
❑ Yes Rl�o
E] Yes 01�o
❑ Yes [a'No
❑ Yes &No
❑ Yes GNO
[9'Yes ❑ No
❑ Yes , O-No
❑ Yes [914o
❑ Yes 133Go
❑ Yes ❑'No
❑ Yes ❑, -N-0
❑ Yes DNo
Comments (refer to:questron #) Explam`any YE5 answers and/or`any recommendattons'or any'other comments: � �
Use drawings, of facility to better ezpla►n situations: (use addrtionaF, pages as necessary) E F f .
H1 e , �iw 2D w t 1 '� £ G u�F(r a U i 4i p.rc r CI rfi� :�. l r £r� •�F+•+f�•+�a ,yY,, Z�.4 L A c, vtaA JDy k LS, L
Ae.) D S P O- . j 4-- 16 . 0VZfL Ac L (Tvt>GQ o p +119 0. I
v �
Reviewer/Inspector Name 9W�
Reviewer/Inspector Signature: 2VOA; Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention: hio
Facility No. G ;7 -
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT. OPERATIONS SITE VISITATION RECORD
DATE: `� , 1995
Time: 1
`� rt�fS�f
Farm Name/Owner:I-WILD46 �q/z.LA q F&2kK. HB
Mailing Address:
County:
Integrator: �4 _ Phone: (gtt)) 3 .)4 ` �
On Site Representative:. P. 0 V`f­--� Phone: t w
} Physical Address/Location: N C S R l 3 0, j �'►^ ' I�l + 6 �_
Type of Operation: Swine Poultry Cattle
Design Capacity: 1 D4- Number of Animals on Site: -
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 4 t Longitude: �� ° �' Elevation: Feet
Circle Yes or No
'Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
{approximately 1 Foot + 7 inches) Yes r No' Actual Freeboard: Ft. Inches
Was any seepage observed from the agoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? a or No Is the cover crop adequate? 0or No
Crop(s) being utilized: Ga��
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? ;0r No
100 Feet from Wells?or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or6;1
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o6) If Yes, Please Explain.
Does the facility maintain adequate waste management recordsumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or
Additional Comments: f2L Pt 0 C_- i X wit D S
0. \�3- ea
Inspector Name
c5
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRANCH = WQ Fax:[phone] Jul 25 'y5 7:31 P.17/17
Site Requires Immediate Attention
Facility Number: 4 7-
• SITE VISITATION RECORD
DATE: sk4,. iZ .1995
Owner ?vt' rA.yr ew-o & Farm Name: .sHrc [ .�•�.�, --
County: O�vr.0 ru.
Agent Visiting Site: ,V eef Phone: fry-i_
Operator: f.c�.,r.•-► A/ej _ _ Phone: --• On Site Representative: -- o .d Phone:
Physical Address: _ cu. ,v o%v--:�.zr.�.�. i ��....; .v �- -� ,_!.r f
Mailing Address:
Type of Operation. Swine' Poultry Cattle
Design Capacity: f �y , Number of Animals on Site: _ . ;.z?_ �
Latitude: 7!f a _'57 DS' " Longitude: 77 O 31`
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 l Foot +$ inches) Yes or(fqo) Actual Freeboard: / Feet s�l_ Inches
, r
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 oni�4Vas there erosion of the dam?: Yes or
Is adequate land available for land application? es r No Is the cover crop adequate? (yj�br No
Additional Comments; gtLt. }�uw•v.�� r.� If TZ cs+aAL a
/bKr+7Aa* _ sry-
d.4�ta
• Fax try (919) 71_5-3 -
Sid*non::re of A