670051_INSPECTIONS_20171231

NORTH CAHOLINA
Department of Environmental Qua!
OX)

Type of Visit 6 C
opliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: OWL, 6 U2(y4N U3 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 0 ' = « Longitude: ❑ ° ❑ ' ❑
Swine 1��gapacitvAnopujadon
Design
Current
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ Da Calf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to FinishEl❑
EGilts
Boars
fro o
d
Dry Poultry
❑ Layers
Non -La ersPullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
Beef Stocker
Beef Feeder
❑Beef Brood Co
Number of Structures:
Other
❑ Other
Discharses & 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 1 of 3
❑ Yes !LI No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
�J No ❑ NA
❑ NE
12128104 Continued

Facility Number: {j Date of Inspection !
Neste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA El NE
P g P q
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: LAZ?ybPL)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
16 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
EdNo ❑ 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 environment71teat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[/No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes
UfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
jNo
10. Are there any required buffers, setbacks, or compliance alternatives that need Cl Yes
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
&o ❑ NA ❑ NE
❑ Excessive Pond ing ❑ 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
LJ o
Ed
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
P
YNco
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
No
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
14A S
of CuR: OUT, Wart-,-IC-1Ntr Wsfi�
PAD zEGLa 191 6-S j GZ 3 YEA MS,
re, Ln
Reviewer/InspectorName 6 NO FAtzN&CL4I Phone:
Reviewer/Inspector Signature: Date: {o g o Q
Page 2 of 3 12128104 Continued

1
t�
Facility Number: (� — Date of Inspection 4
Riquired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
6�No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
o
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
INo
A
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IZK
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes7Ej
NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ffNq
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Continents and/or Drawin k w 5 l � � ,; . � k� �:n�-
Page 3 of 3 12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up U Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Q%Jxf p%j — Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: QAA-u Gug-&A,-JUS Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = { 0 64 Longitude: = ° = [ [= «
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish 1-I.M
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Laver
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current^ ":.
Capacity Population:,.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: (o') —
Date of Inspection Vt forfdjJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: CA 6rcro&)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J* -}
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(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
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
21J WwtE Of (aoNc, w-ftH ALVftAnV( C-QLZPr✓16A)-r, WASTE
AMALYC I S WAS 01,19
`
vv A T E (L ILnnnP f r) o pJ F.t ELD W/o fZC- C *o LQS . G `e ff n 5 SC 4
P vv-,P.%., c-- S `r' S T EVvt
Wo iLC Co K0 s aF P0K&f-r0tY Vat..tvh(-, OR, DAiES,
.
00 -FvZDt-d(_� OF a,IECL. AePv.CA-ra0 NV Dft_. O_- v.OfF.
vCrL� O1R.Y
Reviewer/Inspector Name lsHni FA
Phone:--
Reviewer/Inspector Signature:
Date: i t do-1
1 12128104 Continued

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

Facility Number 5
0 Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
v
Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: i 0 Arrival Time: �� �!) — Departure Time: County: '011J J Region:
Farm Name:
Owner Email:
Owner Name: ,. _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ®iLi9d Z C5 ZY6.11 PAIJ Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Latitude: =] o = ` 0" Longitude: = ° = ` E "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I y I
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
>.I
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
UNo
❑ NA
ElNE
ElYes
U//
o
❑ NA
❑ NE
12128104 Continued

FaMlity Number: (4 -- Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
StructureI Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: &W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 312 �
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[ No
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
�
6. Are there structures on -site which are not properly addressed and/or managed El 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
notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
threat,
2 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
L/J No
❑ NA ❑ NE
(Not applicable to roofed pits, dry'stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
� No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
L Q No
❑ NA ❑ NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
01 o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[YNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LI No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
QrCo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EYNo
❑ NA
❑ NE
l8. Is there a lack of properly operating waste application equipment?
El0 Yes
o
❑ 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):
zq.) CA g-kaf(-
w rTh 30 PA I)s 50 11r
Su12V�.j
Reviewer/Inspector Name J09^1t Phone 71tf79 A^ % 3rV
Reviewer/inspector Signature: Date: 3 v)
I2128104 1 Continued

Facility Number: Date of Inspection ti
Required Records & Documents ,�(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes LI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EfNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
% No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Ek es
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
EYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
EI NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
No
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
No
El No
El"
❑ 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
El Yes
,—,/
D 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?
ClYes
Ql o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number (g') sl
Division of Water Quality `¥
O Division of Soil and Water Conservation
O Other Agency''
Type of Visit OYCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 46 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 7i Departure Time: County: dAiSt4L.
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: DwA L, Alu S
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
�[ ❑Wean to Finish [
r : El Wean to Feeder C[
® Feeder to Finish jda
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts �
❑ Boars
.Other
J❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Region:
Back-up Certification Number:
Latitude: = o = I Longitude: = o = r
Design Current Des�gn� Current
Wet Poultry Capacity Population„ Cattle. Capacity Population;;
Dry Poultry:.. '`-
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures E E.
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
e
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
r;N1
❑ NA
❑ NE
ElYeso
❑ NA
❑ NE
12128104 Continued

F, cility Number: — Date of Inspection 3 L
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?
Structur 1 Structure 2 Structure 3
Identifier: (A600 I
Spillway?:
Designed Freeboard (in): LO
Observed Freeboard (in): 3 y
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ;/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tthh eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes INo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑yes B'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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑NA ❑NE
ff No ❑ NA ❑ NE
ld No ❑ NA ❑ NE
7No
❑NA ❑ NE
❑ 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):
OPPAVE WAM, APP"CATS !)APCKS o(,-- PEO WOP w,T1t x,(L r,>s r
USE tli6 131 ,QA4 RATC. MUST [.oN-rZ90C Ta VAL(. (LV oon�
Ev I �Nbe1 Art►it WAS 6C4_;J C-LOSCD ra PsGr,
14 �) O &-ria_-C4.] co P Y 6( P E R1v Z1 4- G C PLO M 1A014. "L01, N 660 _Pb lab ji.J A(G( y' CA �t(ittr�t
ry SEPT $1) ,466 .
t' "SIr suixec Vos3s$%E Farms. CLOSE ovT
Reviewer/Inspector Name Phone: Q
Reviewer/Inspector Signature: Date: Oj�
Pnve 2 of 3 1212RI04 Continued

Facility Number: li 7 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Doe ecord keeping need improvement? If yes, check the appropriate box below.
L/ I WaBste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
Yes ❑ ElNA ElNE
ElYes No ❑ NA ❑ NE
7es ❑ No ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L,�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No rrN❑
NE
❑ Yes
❑ No
❑ NE
❑ Yes
2<o ❑ NA
❑ NE
❑ Yes
❑ No M"NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes No ❑ NA ❑ NE
❑ Yes 0'9o'— ❑ NA ❑ NE
❑ Yes Elm' ❑ NA ❑ NE
❑ Yes Q>K ❑ NA ❑ NE
❑ Yes CjJ.tF ❑ NA ❑ NE
❑ Yes �❑ NA ❑ NE
Page 3 of 3 12128104

I H 0
Type of Visit Q Compliance Inspection O Operation Review O Structure valuation Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral Emergency 0 Other ❑ Denied Access
Date of Visit: Z i eS Arrival Time: Departure Time: County: Ojffl N� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: P09AG &OK AV US 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: = e =' = Longitude: = ° [� f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I{�' ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets_
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: 1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: (ol — S% Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (A f,2d
Spillway?:
Designed Freeboard (in): 'rb
Observed Freeboard (in): 76
❑ Yes ❑ 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 ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
II. 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
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
I=,
oanswers and/or anvrecammendattons or anyother,comtnents ings of facilityto better e%plarn situahons "(use addrttonal pages pas necessary oj/j aF 46C,T AJVP RAJ 145X6,P o i -ft eC P1-ACCO uwNErZ_ SrA7E3
bur o:r AbG 9usrda's, 1,A4/,V/ LEVEL AT 5mA . am t cvt.0 NErN SATE 4'A
GEr WxrH S6t �✓ 6 SG o Arn/vlErvtoM6►�f' 75 � lbs. Y( P�s� is
10 LAVE sPf-A RP-64, fAA0 A W,'60d STIELL V-7k-) t6 B{ � m�:�* UJ4 rTL L P, G6d/� CO S VRk,, k(La 12 DJ AS G►W,�
Reviewer/Inspector Name r 12d AKA164-1 1 Phone: Q/D 7%
Reviewer/Inspector Signature: Date: /Z/ 1 dJ
12128104 Continued

Ficility Number: '} — Date of Inspection r S`
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA. ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ 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
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings: _ k
12128104

Type of Visit Q!) Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit eRoutine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 3 OS Arrival Time: ® Departure Time: County: (,3St 4)(aJ,_ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: (DQ&Ak.. G uC'. G_&AUS
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
�o
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Pa er
Non -Layer
Other
❑ Other — --- _ - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
I{ Longitude: =o=g
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures: F1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes O No ❑ NA ❑ NE
❑ Yes I o ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection S a S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: (!4G[7_-,,/J I~
Spillway?:
Designed Freeboard (in): Z.p
Observed Freeboard (in): �7
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes do ❑ NA ❑ NE
❑ Yes ao ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L"hr/No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z"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 riwo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
M. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
L ?f o
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
., f
L1Vo
❑ 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) B Er My" 6,0
13.
Soil type(s)
rG R
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
eNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
ffNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
❑ NA ❑ NE
18.
is there a lack of properly operating waste application equipment? ElD Yes
,'No
o
❑ NA ❑ NE
4) ►JEc:.z T, k W CjPY of LA&,)ooJ 06 S.f " WITH 1?fcoo oS,
WvP N6&P5 To 06 VoWl 6Y ZOJC-$ 4 fL 5°(,T-D SIG -F So
A(gC G6 -5 uscp vi/0—zNCr AM (ZICAT_10d.
a_rEeL. R.A ZJ �Aw
Reviewer/Ins ector Name
p � 6<tiit-� <;.
Reviewer/Inspector Signature: Date: SIz4 Le-S
12128104 Condnaed

y.
Facility Number: Date of Inspectionu�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to haA all components of the CAMP readily available? If yes, check
the appropirate box. WUP ❑ Checklists Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes LW No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil alysis El Waste Transfers El Annual Certification
El Rainfall El Stocking El Crop Yield El120 Minute inspections Monthly and I" 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
3 1 . 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 VfNo ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes 6No ❑ NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
�NA
❑ NE
❑ Yes
❑l No
dNA
❑ NE
El Yes
E No
El NE
❑ Yes
❑ No
VNA
❑ NE
❑ Yes
[(No
❑ NA
❑ NE
❑ Yes
LEI No
❑ NA
❑ NE
❑ Yes
dNNo
❑ NA
❑ NE
❑ Yes
ZN o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
12<o
❑ NA
❑ NE
12128104

Type of Visit Qs Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ;0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted © Cerdiiedd ©/Condlitionall Certified 13 Registered
Farm Name: .... enoe'_ ...... _ - ................� .__......
OwnerName: ..... !»._... _l>!.�.... .... _ .. ......
Mailing Address :.........................._.........................
Tune:
Not
Date Last Operated or Above Threshold: ...... ..................
County: .h!L�SI ....... _ _... ...._ ........
Phone No: ................... .. _
Facility Contact: ....................................................................__Title: ........ _ .......... Phone No:
Onsite Representative:.. ,I �.. L��'... _...... Integrator: ..................
Certified Operator:. _ _.. _ .. ._.W_--------------------- Operator Certification Number:................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 '6 Longitude • ' «
DiscbaEges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ spillway ❑ Yes�o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..... ..... ...... ........ ......... ..... ................... ........ -. ............_� ..�- -
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes X No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ONo
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 ;j'No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes &No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ,fNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes eNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes gNo
OPcessivePonding ❑ PAN ❑ draulic Overload ❑ Frozen round ❑ opper d/orrZinc �N z
12. Crop type VINN
13. Do the receiving crops differ with those designated n the Certified Animal Waste Managers t Plan (CAWMP Yes No
14. a) Does the facility lack adequate acreage for land application? �% ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? � XYes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? 'Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ONo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes to
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 A
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑'No
Air Quality representative immediately.
:Com_ments (refer to question #)EzpIain any YES answers anclfo� aay eccmmeadat<offi or any other commeuts. -
;Use drawutgs of facility to better explams�tuaboi�s. (use addiona! pages as necessary) ' 7 ❑Field Co Final Notes f
�/rlic/RC ��GrL4 � /1
/�2.0 �G�f✓7 �oS�
� �0 7 L O/�'r �
�oPS 1 f�eer
.
T
...�_., T�+^
Reviewedlnspector Name 0 �
Reviewer/Inspector Signature: Date:
12112103 V� 91a:3¢�����a � Z J Continued

Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) Yes ❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
R1No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ZE"No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
j2fNo
28. Does facility require a follow-up visit by same agency? __.
P(Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
ZNo
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 Farm ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Add lti&A Comments and&or Drawings
75
/i �iG' �•� /-
�g�
;519Zli GUA �f e A-5 ffI,GT � Od�4 �� 1�4
12112103

i
.y
IType of Visit'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 91ioutine 0 Complaint O Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted 0 Certified © Conditionally Certified © Registered
Farm Name: Gvicee' V1 LIS ' #%.%
T
Owner Name: .LV✓'019U''�Qf�inLis
G
Mailing Address:
Z zI 03 Time: 14 ' 64
Not O erational 0 Below Threshold
Date Last Operated or Above Threshold:
County: '0r1SIOL-j
Phone No:
Facility Contact: / Title: Phone No:
j'� y�
On site Representative: _ � wrA) C�+J'"�q'�� S Integrator:
T
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes gNo
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)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 5
[--]Yes ❑ No
❑ Yes ❑ No
❑ Yes PNo
❑ Yes ONO
❑ Yes ONO
Structure 6
05103101 Continued

Facility Number:
Date of Inspection 21 p 3
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?
❑ Yes ff No
❑ Yes J�A0
❑ Yes �No
❑ Yes 'ONO
❑ Yes JO No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
El Yes
r,/
ONO
No
l 1.
Is there evidence of over application? ❑ Excessive PondinJg PAN ❑ Hydraulic Overload
❑ Yes
j2fNo
12,
//❑ 1
Croptype IIerr+„ofa �r�atel Ca►nr'}a•�&r vatrl {,�aZ�1 Sr�a�l G/�'t'1� I1 J�s�'r��^�►¢1'
)
i`'"7vd
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
,ryes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
Oyes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
0Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
j2l�o
Reouired Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 2:rNo
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) Oyes ❑ No
20, is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ZrNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ict discharge, freeboard problems, over application) ❑ Yes .�YNo
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes dNo
24. Does facility require a follow-up visit by same agency? ❑ Yes .ETN0
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? Yes JMQ0
[j No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
om�ents!(refer �to'question #) : Ea:pLvniany#YES.answers and/or any recommendations or any other cornmenfs.
,..
, 4
Use drawings of facility to better explain stuahons '.(use addr4onal'pages as necessary) [] Field Copy ❑Final Notes
!3. rCSGve iT ian-���( :-+ .byte �;e�d 41.R4 qAe Was4e
0 l' W h P. tH rz� �-V DI s v V,,% e r Otrl 1 L, a
is. F, rhQ bef�..!da :girds qS des;aI tR�eo( 'n -�lre ���� Liave r��i►�
ai l7 i'� Of �C� S G 4�i.0 � "� '(1'L e ►'h .
1q. A weir-ble ac-eS d6,4eeyn1rn44',91+ t.1- '"'ceded�}�
L,v0,54e. plAvl . 7 t e s vlv1p 4, qj J do c, yr rills should be drt ��e ��, �...t
r
Reviewer/Inspector Name �—
Reviiewer/Inspector Signature: Date:- Z
05103101 Continued

.> Facility Number: (,7 — $ Date of Inspection ZI a
Q-dp-r Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
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 Iocated 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 permanentltempormy cover?
Additional Comments and/or Drawings:
❑ Yes ❑ No
❑ Yes ONo
❑ Yes [3 No
❑ Yes M—No
❑ Yes ,�No
❑ Yes J21Go
❑ Yes ❑ No
l'.CQn4;,%J,-,dO'1C'e Otte weWcibla o�C,reS ; S GG►^le e.,4 , M'• 6u�4►f
&Cl i e'vt s � Ej ens : vd. Lia s doh eso -1e W o /7 a'n 4-tl,'s .
please ge-i-�d9e-��e�- �iI�`i� Vdg.O14eGhrticci1 av►ViSows 40
CO-Iflele o► weHAb)e vay*J jr3(e��Yr--1:r:,a-�;o� ivdl, -+ '%^4clo.e,
LvIl Ae plAii. f l ea5e A i ve -Flee ylan in c l vde 4 k,► f J
mee-1 ypu,. des;, -es Lah Je S-l.'11 �rot��'d;n� adegva.je hO'C'gen
vp-lake otn4 4keoi Follpw 1e plak1 .
l 9. Be s ve-e Jo brave a�- k/as4e sa••►,p 1 es
of!
alOI,, e. Iq ate+ e-vei��s� 4 4ere -0i s
e/hba, A►i ¢q/l 0& ote, Zo Z
if. Phase ir141vote 1a.gao�. des,'�ph 1,13-11, I�ur t'CGor(f.
h r•e i 1 a y�od e r or or -( SC'Ix z1lLterP i-1 has (9e011% jv1gn7e10(
be ulo,-keol you — P l ez"i. ylot4v >re c. o'-ds
'C�tdo raveir l l j •ieg411 keP4 qeiof
-<W: tie Le.cIlse gre4 q-14 1-igoo-i nee'well mowed a✓t ��c'
-E',-eeboarpf level ;s 9cod. ?'hank Y04 -to-
r/e-iSe .4ddress -44e eibove
4 4e
S,
l er►� �o[a geld s as is Tel i✓.red by 41e_e Plan . Flee,se be svry
4,0 roll ew -J11t P10101
05103101

r -,:
Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f0 Routine 0 Complaint 0 Follow up 0 Emergency Notification Q Other ❑ Denied Access
Date of Visit:
Facility Number
Permitted © ertified © Conditionally Certified U Registered
(((Farm Name: //��
Owner Name: _ '0 PA i�
Mailing Address:
Facility Contact: Title:
Onsite Representative: aw&&z t'k:5
Certified Operator:
Location of Farm:
Time:
Date Last Operated or Above Threshold: _
County: ��4.1-0AJ
Phone No:
one No:
Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �1 GL Longitude ' '
Design Current
twine
U Wean to Feeder
Feederto Finish
El Farrow to Wean i i
Farrow to Finish
Gilts
Boars
Number of Lagoons I�
Holding Ponds 1 Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle CaiDacitv PoiDulation
❑ Layer ED
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total SSLW L
Subsurface Drains Present 10 Lagoon Area
No Liquid Waste Manaizement
Disci & 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 reacts 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 & T_rgatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
J Spray Field Area
❑ Yes/No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Structure
Continued

r 16
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Ye No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses as
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? A Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ANo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes INO
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes X.
11. Is there evidence of over application? ❑ Excessive Ponding p PAN El1#40mulic Overload I ❑ Yes ANo
12. Crop type
13.
Do the receiving crops differ with those desig4ated in the Certified Animal Waste Man ment Plan (CAWMP)?
Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15,
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
�NG
Required
17.
Records & Documents
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
0 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
9No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
VNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
X.
24,
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
INO
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Ca�ments (i efer to gueshon #) Explam any�YES answers -an d/or;anyarecommendatlons or any Sher comments
Use drawin s of facile to better ei 'larri situations: use additional a es as>necessa
g p 1 iP,g n) Field Copy ❑ Final Notes
�Ty ,
Iz 'T . ,54 0 lW- 4-7 �r�o G��,� / �WI)719102 A1414&_
r . yam/ [ 1I / �/ / • ��� v _ ' / D�S�� F /�O � ! ��6��0�f �/'-r (..�
Reviewer/Inspector Name's
12
Reviewer/Inspector Signature: Date:
05103101 �. f 1 f Continued

Facility Number: q7 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
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?
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes VJ No
❑ Yes �No
❑ Yes �No
❑ Yes � No
❑ Yes ❑ No
:Additional Comments;andlor Drawings:
e)
02 Z1904
l L /'�� � 2� � :5�� Ste► �°« s,
F Z/A) Z;
05
be
2. 8�
� 7Wc 2-,2 s
f �
fD
kfc�L=
f
�4�oeos*
05103101

Division of Water
O Quality
an
DiVision of Soil e_
`^ a Q'Other AAgenCy s r { x �s F*
Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Beason for Visit Routine Q Complaint Q Follow up 0 Emergency Notification 0 Other © Denied Access
Facility Number
Date of Visit: a �-� Tim-ls e: Printed on: 7/21/2000
'rf it
Q Not Operational Q Below Threshold
Permitted ©Certified][ [3 Conditionally Certified Q Registered7-11�Date Last Operated or Above Threshold:
Farm Name: �c•�r�\ �.� ...... County: .....G...�.t}�..G.\n.t................
Owner Name: .....
Facility Contact:
Mailing Address: ...
Onsite Representative:.Q!!' ,•
Certified Operator ....................................................
Location of farm:
Phone No:
Title:
Phone No:
................................... ................................................................................
.................................... In tcg rato r:............c-..
f................
.................................... Operator Certification Number: .........
rt
[:]Swine []Poultry []Cattle []Horse Latitude �' �� Longitude �• ��
Design Current
Swine Canacitv Population
❑ Wean to Feeder
Feeder to Finish
1UU
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
LEE
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer JE1 Dairy
❑ Non -Layer I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag—n .Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact;
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c- If discharge is observed. what is the estimated flow in gal/min ?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure , Structure 4 Structure 5
Identifier: ......................................
Freeboard (inches):
S/00
❑ Yes Xlo
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes RNo
❑ Yes }XNo
Structure 6
Continued on back

Facility Number: — 7� Date of Inspection Printed on.• 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 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 ,fNo
(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
MNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
AM
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
b'No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�fNo
11. Is there evide ce of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
J�'No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
1�fNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
qNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
D<No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
ElYes
N�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
)�rNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
D(No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N1No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
N'No
22"
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
RNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
NJ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Wo
N ViOiMi6ils.ol' de�Cle diif WCrC JnUed-d&ii1� this'vislt.-Ybilt Wiil-Cebe it© UI'tlleT
corresAOn[len' &'aboi ukth1k.Vlslt..'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.".'.'.'.'.'.'.'.'.".'.'.'.'.'.'.'.'.%
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):
ti Qn ((
a�Y����-�..s- k��- � ��� ��--e. a-- �• d� l�1-�-� �-,per-�
Reviewer/Inspector Name 1 k QA
Reviewer/Inspector Signature: Date: ':;z g/pp

r' Fa ity Number: — 5 Date of inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 1�(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 JnJ No
30. Were any major maintenance problems with the ventilation fan(s) noted? Ox. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,� No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes] No
..Additional Comments and/or Drawings: -
5100

Division of Water Quality
ivision of Soil and Water Conservation
O Other Agency "
Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date ur visit: � rime: [= Printed on: 7/21/2000
0 Not Operational Q Below Threshold
#Permitted 0 Certified{ ©Conditionally Certified 0 Registered Date bast Operated or Above Threshold
,Farm Name: ....................................................... County: ... 0. 4L-�.....................................................
Owner Name: ......................................... . ......
FacilityContact: .................................................................I
Mailing Address: .................................... .
Onsite Representative:.. {^ ..................................
Certified Operator:.......
Location of Farm:
......... Phone No:
Title: ................................................................ Phone No:
........................... Integrator:...... `\1!
.......................... Operator Certification Number.......................... .
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �6 .6 Longitude • ° «
Design Current
Swine Capacity Ponula6on
❑ Wean to Feeder
Feeder to Finish -
=0
❑ 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 IF] -Subsurface Drains Present ❑ Lag—n Area JE3 Spray Field Area
Holding Ponds / Solid Traps JE3 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min`?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes N No
❑ Yes ff No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes j(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
•Freeboard (inches): 3a
5100 Continued on back

Facility Number: 1.0— Date of Inspection 7_1 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[I yes
�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
Yes
❑ 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
ONo
11. Is there evidence of over application? ❑ Excessive Ponnding ❑ PAN ❑ Hydraulic Overload
❑ Yes
XNo
12. Crap type l
12
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)'?
Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
C�(No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15_ Does the receiving crop need improvement'?
tKYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
JRNo
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_anaiysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.: Vo-Aoiatigns:or• deficiencies were hated• during this'visit'. - Y'oii will -Teceiye Rio: further
.. ..
.. corres}ioricience: abuu> this .visit.... .
❑ Yes hg'No
O(Yes ❑ No
❑ Yes (KNo
❑ Yes [XNo
❑ Yes ONo
❑ Yes 1�f No
)9YesNo
❑ Yes XNo
❑ Yes 2�No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�asct4 y��r, `1"1 YeC s, \V-es 1 _e�t��-
C�. �1^-•`l`-tip d',c-.2 �-�, Cl�'e"- `'�4at�•� 5`�^�� � �' .
T))

Facility Number: — Date of Iuspection Printed on: 7/21/2000
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior helow 9Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes qNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J�'No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
3I. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes MNo
Additional omments and/orDrawings:
Q
kS
�
t
Y
5100

i
Lagoon Dike Inspection Report
Name of Farm / Facility _S. uryanu& Dur 1�(Murphy) 67-51 A
Location of Farm / Facility . Sr_1201 2213
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, xH:1 V
Embankment Sliding?
( Check One, Describe if Yes)
Seepage?
( Check One, Describe if Yes )
Erosion?
(Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
9/29/92 Names of Inspectors Paine-k Grogan
7anet_Pad
7' Freeboard, Feet 16"
1.5 Top Width, Feet 8
210 1 Downstream Slope, xH:ly 3 to 1
Yes _ X- No
Yes _X No
Yes _X No
Excellent -morass
Did Dike Overtop?- Yes X 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 X No
Other Comments This is the laeoon_awav from thr, hQus s -
►M

Lagoon Dike Inspection Report
Name of Farm / Facility _ GurganuE. Dun! (MurpWL 67-51 B
Location of Farm / Facility -Sr 1201 2213
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
_ 9129/99 ^ Names of Inspectors Patrick Grogan
J Raith
3 - 5' Freeboard, Feet b"
— Top Width, Feet 3-8
s
Upstream Slope, xHAV
2to 1
Downstream Slope, xH:1v 3 to 1
Embankment Sliding?
Yes
X No
( Check One, Describe if Yes )
Seepage?
Yes
x No
( Check One, Describe if Yes )
Erosion?
Yes
No
( Check One, Describe if Yes)
Condition of
lixcellent
- grate_
_
Vegetative Cover
( Grass, Trees )
- Did Dike Overtop?
Yes
X No
If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed?
Yes
X No
Engineering Study Needed?
Yes_
No
f
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Yes X No
Other Comments
This is the lamnn closest
to the houses. Needs to be
contacted about
FM-P-ins-
•— _

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number -- - J 1 Operation is flagged for a wettable
. Farm Name: ,7 _ acre determination due to failure of
On -Site Representative: Part 11 eligibility item(s) F1 F2 F3
Inspector/Reviewer's Name:
Date of site visit: 9
Date of most recent WUP: !
Annual farm PAN deficit: pounds
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: 1. hard -hose traveler, 2. center -pivot system; 3. linear -move system;
®stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete"=
and signed by an I or PE.
E2 Adequate D, and D)D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and sinned 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% fule.exemption as verified in Part III. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational table in Part III).
PART 11.75% Rule .Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required -because. operation fails one of the eligibility
requirements listed below:
_F1 Lack of acreage_ whichTesultedin:Dver:applicationmfwastewater_(PAN) onapray_
f eld(s) :accordingiofarm'siast-two yearsmf-.Tmgation-xecords.
F2 Unclear, -illegible, -or lack of informationfmap.
F3 Obvious -field -limitations -(numerous itches;failurefo:deductTequired :...
bufferlsetbackmcreage;-or25%-_of iotaf -acre ageddentifieitdn-_CAWMP.--includes
small ;-irregulariy-shaped.fields --:fields -less-than-5 -acres-fortravelers-or-lessthan
2 acres-for.stationary -sprinklers).
F4 WA determination required becauseCAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III_

Revised April 20, 1999
Facility Number(li�
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS'
NUMBER
NUMBER',2
IRRIGATION
I
ACRES
I
ACRES
%
I
SYSTEM
3va5 l � �3
a lg
3 o a.os
1
d
FIELD NUM13tKI - hydrant, puft,zone, or.point numbers may be usea in place of tieid numbers depending on CAWMP
and type of irrigation system. - If pulls, etc. cross more -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 NUMBERZ - must be dearly delineated on map.
COMMENTS' - back-up fields with CAWMP acfeage-exceeding-75% of its total -acres and having received less than 50%
Of its annual PAN as documented in the farm's..previousfiero years' (1997 & 9998) of irrigation records, cannot serve -as -the
sole basis -tor requiring a WA Determination.=Back-up Meldsmust-benoted in the comment -section mnd must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
Pi Plan 1acks.following -information:
P2 Plan revision may-.satisfy-75% rule based on adequate overall PAN deficit -and by
adjusting -all field acreage:to below 75% use rate
P3 Other (iern process of installing new irrigation system):

` 0 DMsion of Sort and Water Cvnservatrort ,Operation Review
e
[r Drvision of Sod and Water Conser�atron Compliance Tnspechon
�Drvrsivnof Water Qualrty Cvmplaance Inspeehion
-M
m
E1.flther�A-nev_[]riera
IQ(Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection L cHuLm-
I
Time of Inspection o O 124 hr. (hh:mm)
© Permitted J2 Certified © Conditionally Certified 13 Registered JE3 Not Operational I Date Last Operated:
4. County ..._.._.....�
Farm Name- . •......................................................
OwnerName: ................................................. ..........................................................................
Phone No:.._...................._............_..............................................,
FacilityContact: ................................... ...........................................
Title: ................................................................ Phone No: ...................................................
MailingAddress: ............................................................
........................................................ ..................................................................................... ..........................
Onsite Representative:. .............
.............. .... ......... Integrator:................ `?......................................
Certified Operator: ................................................... .............................................................
Operator Certification Number:(..........................................
Location of Farm:
Latitude �`�° ��° Longitude
❑ Wean to Feeder
Weeder to Finish
I-Xp Z}
❑ arrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PNo
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 DNVQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min!
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [INo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes tR'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: tr1�►^t a�4
Freeboard (inches): ........... ? b................. .............. ......................I............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes JXNo
seepage, etc.)
3123/99 Continued on back

Facilisv Number: — Date of Inspection
4jAre 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 maintenarice/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 aver application? , ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (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. �Cio yiolaficjris:vr de eiei�ci.. were ho(ed• ili. WI this'visit: - Yoit wiil-i•eceiye 0ti futth&
coriesnoridence-a�ou this visit:: .
C©minents (refer;to question #). Explain vany YES answers and/or any recommendatiows or. -any other comments
Use drawings of facility to better explain situations ;(use additional.pages as necessary) Y
r7) t_� K-CA-4 L_
XYes ❑ No
b(Yes ❑ No
❑ Yes JWNo
❑ Yes 5�No
❑ Yes [)(No
❑ Yes )An;keNo
❑ Yes �(No
❑ Yes ❑ No
"M Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes %No
❑ Yes j(No
kYes ❑ No
❑ Yes C�rNo
❑ Yes n No
❑ Yes � No
❑ Yes ONo
❑ Yes 0 No
❑ Yes [�'No
❑ Yes QrNo
Reviewer/Inspector Name_,-1
Reviewer/Inspector Signature:
Date: W-5r —
3/23/99

Facility Number: — S Date at' Inspection
( or Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below Yes ❑ No
. liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ElYes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 19No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? lwYes ❑ No
Adclitional Cominents'an
or_ rawings' _ _ -` - -
(
A,
3/23/99

Division of Soil and Water Conservation 0 Other Agency
M Division of Water Quality
KXRoutine O Comalaint O Follow-uu of DWO inst)ection O Follow-uu of DSWC review O Other
Facility Number
Date of Inspection
S
Time of Inspection [=�j 24 hr. (hh:mm)
Registered 10 Certified [3 Applied for Permit © Permitted [3 Not Operational Date Last Operated:
Farm Name:.�3 .S1C�.�T�Ft(1�..BLS..............Y ! ...... I................................... County:...... . ?5.`,Cf J..--.................................
Owner Name:... -Du Q n- ci YL G f1 nJ i1 S Phone ?Vo: 7.. ...............................................
......................................................................................................... ................ 9
Facility Contact: ... ,J. .IQ .... .G � ���.... Title: (19Wk) r ,1................
------------- Phone No:............... .................
Mailing Address:.......LS!.:1. .....11r/i�G��.^... .r�......... T%��� ............................... .......... ... .. ......................... .....��...........
Onsite Representatives.. 'f .--19 vrd i/s b4b t;
..................................................................... Inte rator:.... �fle�r,
Certified Operator�Rli.L".....(Tk."dV.VS............................................ Operator Certification Number:.........................................
Location of Farm:
Latitude • ' " Longitude ' ` "
_.Design., Current Design Current Desrgt► Cui<cent
S�vuree
ri
Capacity- Population ; • Poultry - Capacity Population: " Cattle , x . .,Capacity;: PopplaHgn ' r
❑ Wean to Feeder
❑ Layer ❑ Dairy
W<.
er to Finish
❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
w.
❑Other ° rr
❑ Farrow to Feeder
[] Farrow to Finish
Total Desi II Ca aCltu
g P Y
❑ Gilts
6
v Boars
�-:Total SSLW
Number of Lagoons / Iioldtng Pone
❑ Spray Field Area
❑ Subsurface Drams Present ❑Lagoon Area
.
,
N
EON o Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes JE@ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes WN0
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes R No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 51 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ONo
7/25/97

Facility Number:
tty n co ce th p ' able s c rite ' ti e of design?
fac' 't � to h a -e o or in r sponsi ?
S. 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): Str ce I Structure 1 Structure 3 Structure 4
.....................................................`.... ....''S.................. ............. ........... ................................
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 runoff entering waters of the State, notify DWQ)
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
00 No
❑ Yes
allo
Structure 5
Structure G
.......... ................... ................
❑ Yes
I..............
® No
,91 Yes
❑ No
15. Crop type ................ .......................................:`.1................................................................................................. .
lb. 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?
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?
IN Yes ❑ No
0 Yes ❑ No
❑ Yes ® No
................................
❑ Yes ® No
❑ Yes O No
Z Yes ❑ No
❑ Yes E) No
❑ Yes ® No
0 Yes ❑ No
lit iz/O ItlAe.1 re 1;,Lo, - � '9;'4/ / ., 0." :�- 4-"'" e­ —
A"7 he
WW �f i-YA �%4t!"' � //� r,i✓ `�r� lr t!-�.W GYl;�
Reviewer/inspector Name 4; f/� �6 rfe'� h �
Reviewer/inspector Signature: ,g Date: /0
❑ Yes 9 No
Yes 'va-)
❑ Yes [B No
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

❑ DS WC Animal Feedlot Operation Review
i U DWQ Animal Feedlot Operation Site Inspections
i
€"
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSIVC: review Q Other
Date of Inspection 4 ?
Facility Number 5 Time of Inspection tp 24 hr. (hh:mm)
Total Time fin traction of hours
Farm Status: 13 Registered ❑ Applied for Permit (ex: L25 for 1 hr I, min)) Spent on Review
❑ Certified Q Permitted or inspection (includes travel and processing)
❑ Not Operational I Date Last Operated: .........................................................................._..I.........................(..........................................
Farm Name: nU.s/...... i'Y................... Countv:...... - }i� ...... ,ri IJ ......... ... ....................
Owner Nance:•.....5. j.........&.�}..AV1..................................................................... Phone No:...�.` 10.134.4L...��$`f..........................................
Facility Contact: ...... .........[....... ...�7..itfs'AuS ....................... Title:.... 1QLJiW.................. Phone No•�i��� ���.��'��
Bailing:lddress:........b�.�4.....1LlrlltlS.....S7.R. ...................................................... �i�G�1l....t'S:.�......G .......
t� �+-..................................... .. I .............
Onsite Representative:.....�!1.Eh!J�.t&.......!-lG.'.W(!t.11.......................................................... Integrator:........ M..........................................................
Certified Operator:..
Location of Farm:
Operator Certification Number: ...... {..1.............
wayr,A.3�1&FW..�.. &MX.X3........ E.QG.I..A...I�1[.1./UGI,....r.1f7/ /....ate{/.. t.:..
3].st.ts..LO6... Q,..1 0t.fST....ILT .lX�{�4...
Latitude Longitude rAcs
Type of Operation' ' Design Current Design ,Current
swine Capacity Population '.....:Poultry Capacity Population Cattle.,
r
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non-Dai
El
Wean to Feeder
j��Feeder to Finish
i
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
.... ............... _
❑ Other
ber of Lagoons'/ Holding Ponds
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If dischar-e is observed, what is the estimated flow in sallmin?
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?
I��cMRA
-C `f nu115 tb,
Design': Current
Capacity Population_ --
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes [9 No
❑ Yes P No
❑ Yes
No
❑ Yes
No
❑ Yes
UNo
❑ Yes
[PNo
❑ Yes I)i No
❑ Yes J9 No
Continued on back

Facility Number: o-
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
Q�No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Wo
Freeboard (ft): Structure I Structure 2 Stnucture3 Structure 4 Structure 5
Structure 6
.....?-. Z.....................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
0 No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
® Yes
❑ No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any or questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
[2 No
Waste application
14. Is there physical evidence of over application?
❑ Yes
W No
(If in excess of WMP, pr�runoff entering waters of the State, notify DWQ)
15. Crop type ... C i')?n!.(�............................................. ....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
® Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
WYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
For Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
24.
Does record keeping need improvement?
U Yes
❑ No
I I.112— E,reslur. c rcas v►. 4L i nwr-/pdke� wc4(( of l0. be 41(,cj Wi
rrseeaej. gt;rc is s4+ou�� vrse�de�. {+.t�,� o waltz of (a�� s1� �e meowed•
�. v�aa�� �t,l � wash s�i,zs ��,►la lie .,. Sem.,y .rtcor�s 5f�nv[�j �Q K{.p#-�
is v rvyn hum6e ctn� (-i c W * kw„ ler.
No P 16K o v-
-1� ah Side.
Reviewer/Inspector Name
Reviewer/Inspector Signati
cc: Divisiat of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention: AJG
Facility No. 69 7— ,3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO S PITE VISITATION RECORD
DATE: ?,(P , 1995
Time:
Farm Name/Owner: _ _- _ _ Dulbq_t � S ��6)R 100
Mailing Address:
County:
Integrator: Phone:
On Site Representative: Phone: 419
Physical Address/Location:
Type of Operation: Swine - 14 Poultry Cattle Design Capacity: JI � Number of Animals on Site: 1I0 AVYIj Yl rA
DEM Certification Nu ber- ACE DEM C rtificati n Number: ACNEW
Latitude: Longitude:' I. Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have ufficient freeboard of 1 Foot + 25 year224 hour storm event
(approximately 1 Foot + 7 inche Yes r No Ac al Freeboard: 3 Ft. Inches
• Was any seepage observed from agZsr
? Yes r No as any erosion observed? Yes r N
Is adequate land available for spray o Is e cover crop adequate Yes r NoCrops) being utilized:SC(Jei
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellingForNo
No
- 100 Feet from Wells
Is the animal waste stockpiled within 100 Feet of USGS B1ue.Line Stream? e
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 o he state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate was a management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No/i,, //&jrr
Additional Comments: .6L/3 • /,/��'dSf �l � e_7 /
• LLLI
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRANCH - WO Fax : [phone] Jul 25 ' 95 7 : - i P. 16/17
Sitc Requires Immediate Attcntion -�
•
Facility Number: - EZ
SITE VISITATION RECORD,..
DATE: Tyr c ! ,' 1995 = ; �-
Owner: -0jgfAdt4 aAotg.sv14I Farm r. fy Name: f' cr.oww rr., _ ezor .r
County: dLO[,� :�'•.+�:i. i 1. :`k -
Agent Visiting Site: •x t xPhone: ty. f
Operator.. nc.vr Phone: L�/ol Zs;s�- r deOn Site Representative: V 4e4,v G acrc v.,v. �.. _ _ PlYone:
Physical Address: `.G �p r...: r,s..�.-•..,. .eT �." �: .t r �o�.�..
C.%ox-r ;} -4p 0 e 07wr ti Vol -
Mailing
7 tf
Address: V
Map le
Type of Operation: Swine gf Poultry Cattle
Design Capacity: efyd Number of Animals on Site:
Latitude: e .. Longitude: - ° '
Type of Inspection: ' Ground Aerial
C'ir•cic Ycs or No
Does the Animal Waste Lagoon have sufficient frceboard of I toot + 25 year 24 fintrr Morin event
(approximately I Foot f8 inches) � or No- Actual l:rcebo'ard: _�Z Feet _,.�— Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed From the lagoon(s)? Yes oro- NVas there erosion of the darn?: Yes orf[P)
Is adequate land available for Iand application? ke 4r No Is the cover crop adequate?r No
Additional Comments:
Fax to [phone]
naturc of AzFnt