670056_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual
II

(Type of Visit: U CactypHance Inspection Q) Operation Review Q Structure Evaluation O Technical Assistance +
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other O Denied Access I
Date of Visit: Arrival Time: Departure Time: DZES-1 County: oN ok? Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ?14=-47P SAGPA2D
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: 6q
Certification Number:
Certification Number:
Longitude:
Design
Swine C*apaclty
Wean to Finish
Current
Pop.
Design Current Design Current
Wet Poultry I ffC_-ipacity Pop. Cattle Capacity Pop.
Layer I I I Dairy Cow
Wean to Feeder
I
INon-Layer I I
DaiH Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean "p
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
D-MyIP0751tr, Ca aci P,o Non -Dairy
ILayers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar cs and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the dischargc reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Zo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facilit Number: fal - Date of Inspection: -LA
blast' -follection & Treatment
4. Is stor ge capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: '
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment
I threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
gNo
❑ 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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Wo
1. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L1J "
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
W
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[No
❑ NA
❑ NE
_Reauired Records & Documents
19_Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Inspections
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �/No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: 7,0
MVNo
24. Di,? he facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o [:]NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No [] NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yeszl�o
�] NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ej Tio ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
iments (refer to question-#):
drawings of facility to better
Reviewer/Inspector Name:
any YLs answers analor any aaat,
situations (use additional oaees as
❑ Yes PNo ❑ NA ❑ NE
ons:or:any other comments.
Phone(910 1 ! 6 13 14
Reviewer/Inspector Signature:
Date: Ll M6
Page 3 of 3 1 21411015

ti
(Type of Visit: DACompHance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit:outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a Arrival Time: Departure Time: I County: 0115L.60 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: % Az.Ll. ::'R Si4 cel; en Integrator:
Certified Operator:
Phone:
Certification Number: I ?
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
C►urrent
Pop.
Deslgn C+urrent
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pvp.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
d
V
Design Current
Dt, P,nultr. Ca aci P,oP,nultr. Ca aci P,o
La ers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turke s
Turkey Poults
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Y o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
N
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

[Facility Number: - S jDate of inspection: `'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier: LAG-,-ov
Spillway?:
Designed Freeboard (in):
n
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmZo
threat, notify DWR
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA NE
❑
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑
7. Do any of the structures need maintenance or improvement?
❑Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes�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
ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
No
❑ NA
❑ NE
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes YNO ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ZNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
0 1`10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [IYeseNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CZK�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ✓[ No [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
r'
[2/No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
0N'o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
2/No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on representative?
❑Yes
9No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
i
[�fNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any`other co►riinents.
Use drawines of facility to better explain situations (use additional paRe3 as necessary).
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: G
Date: S
214 014

(Type of Visit: q) Cliance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: �%d I �' County: OAJSL60 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: Q
Certification Number: U 6 �`
Certification Number:
Longitude:
Wean to Finish
I I Layer
I
I Dairy Cow
Wean to Feeder
I INon-Layer_ j
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D,r. P,oultr Ca acr P,o ,
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3- 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2rNo ❑ 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 (00)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes b(No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No [DNA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment l threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes] Nvo ❑ 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 N ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): i
14. Do the receiving crops differ from those designated in the CAWMP? .
❑ Yes Eallo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Li o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ZNNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ��No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [�No
❑ NA
❑ NE
the appropriate box,
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements . ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o [] NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -C.,Date of Inspection: 9A,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E[DNA ❑ NE
2S. Is Ole facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesWo
o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes go ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �2/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes i �J No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
LLI� 61 SI lJ GE
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone
Date: 11 1
21412011

Type of Visit: U Co Hance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 1 Arrival Time: $ S7 Departure Time: County: 0yJSV01.j Region:
Farm Name: Owner Email:
Owner Name: (Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �� �.��J� SrJ ( PAokb Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design
C►attle Capacity
Current
Pop,
Wean to Finish
Wean to Feeder
Layer
Dairy Cow
I
INon-Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Dry Cow
Non -Dairy
S
Design Current
Du PIL . Ca aci P,a ,
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes [ ❑ NA ❑ NE
❑ Yes No ❑ NA [] NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAC
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 6 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [3/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? . ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑Yes [/] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes O/No ❑ NA ❑ NE
❑ Excessive Pending ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[3 Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VIN�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes N
❑ NA
❑ NE
acres determination?
/No
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
o
❑ Yes�'No
❑ NA
❑ NE
the appropriate box.
❑WUP .❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �lVo
A ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

I
Facility Numbgr: 'j - Date of Inspection: q1z413
24. Did t�c facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No [DNA ❑ NE
and report mortalitv rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [Z/No
❑ Yes d No
❑ Yes [Z( o
[:)Yes No
❑ Yes
❑ Yes C No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or.any, other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewed]nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `716 1,,, Jn
Date:
21412011

(Type of Visit: UCo iance Inspection () Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: A_W Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: g0T,LL--'re ,�j14(--twt Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1 g9bgg
Certification Number:
Longitude:
Design C•uerent Design C=urrent
Swine wcapacity Pop. �'et Poultr.y Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
can to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
(j
Design Current
Dr, P.oultr, Ca aci P.o .
Layers
DairyHeifer
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
©ther
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes j(No ❑ NA ❑ NE
❑ Yes ��o ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection: z-
)Xaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: j,�i�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2j No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 1V ❑ 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 YNo
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes Q o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[:]Yes VNo ❑ NA ❑ NE
❑ Yes E2� ❑ NA ❑ NE
❑ Yes []o ❑ NA [] NE
❑ Yes ❑ NA ❑ NE
❑ YesjNo❑NA ❑ NE
❑ 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 0 Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes �o [] NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection:
2f . Did the facility fail to calibrate waste application equipment as required by the perm 4? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [3 Failure to develop a POA for sludge levels
V❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 2f No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes DNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
� o
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
CdNo
❑ NA
❑ NE
[] Yes
ZNo
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
do ❑ NA ❑ NE
Wo ❑ NA ❑ NE
No ❑ NA ❑ NE
jComments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.. °I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhonetQW-776-719
Date: 7 rL•
21V20II

Type of Visit Qq Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: Arrival Time: 30 Departure Time: County: 4>VSL,06,' Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ?6JZL%-" C SHEPq(LD Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o = I 0 11 Longitude: 0 ° = t 0 ;{
a..:f'; sf`q.g'� s.. _�4r,E .�A �.��„"+ers} .�t7'4i�s
t .•. , Design, Cur„rent �, f� Design Current ;.1 ..:: Des�gnA'C;urrent
:.;.e'1 ;G.,:r f P."`F:rz'!'o:'a f�•®:•`�'4yr�,g ri. e r:. cir®'r. .:8 Y.>aa",: :rr+`r.atj ,"` y.�, d.«�a,,s,;?."s �P •,.�:I 'v.+:P°r.
Ty
a Swine $ Capacity - Population �Wef'poultry �=Citparactty Population=, s Cattle l a tglCa ac'rty Populattom
r
a', ❑ Layer
❑ Non -Layer
f
AjjjrfflY Y ; s>
s"
[] Layers
❑ Non -Layers
❑ Puliets
� ❑ Turkeys
Other sg , �, rA ❑ TurkeyPoults
. ❑ Other ; ; .. ; . ❑ n ruc
Other Number of St `(tyures
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 1 of 3
❑ Yes E�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 13�No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: 6 —$f.
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LACnm a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �- ?
❑ Yes Eko ❑ 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
,_.f
E No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
El 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 ,
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
r r r� - s1i � :i.r$ ��",.��.�k��
.Comments (rcferto=question;#) Eiplain,ariy YES;answers and/or any recommendatirons or ariy�other. comments ,�x;
_it betti lain situations. use additional a s as necessar H y
'Us' drawn s'of raciEto cr.tp (
- ..d :' - - d! °-y ,"f�' i ra`' � :'•' r.d aJf'$3'4r'''.�:'i` i���;�'iI'i.. '. .'."S�
�
So�C �t�rnP2i`/6. &_A' ' FS try /hA IZCM Of 6 0 -To V MOVESG-7 To 13 &tPAVV 1.
AL
Reviewer/Inspector Name Phone: ! 7 7'5 O6
, a
Reviewer/Inspector Signature: /L Date: 3 rfZ3 I)
Page 2 of 3 1 12128104 Continued

Facility Number: �� — S(, Date of Inspection 2 i
Reauired 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 E�No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checkiists ❑ Desi n ❑ M ❑ Other
b aps
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
I/ 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 [:1
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
{ No'
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
'Yo
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the pen -nit?
ElYes
1—'I No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LJ 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?
El yes
�L�J
O� o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ECNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�,
LJ'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
12�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

6
Type of Visit 7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Dented Access
Date of Visit: _� % Arrival Time: Departure Time: County: 0
MLOk/ Region -
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: P LLIF y1&Poq&2
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = I = {1 Longitude: = ° 0 ` ❑ "
ffMDesign
C*urrent
Design Current
Design Current
Caper�ty
Population
Wet Poultry Capaty Population
Cattle Capty Population
Wean to Finish
❑ La er
❑Dai Caw
Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
❑Dai Heifer
Farrow to Weans
Dry Poultry
❑ D Cow
Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑Non -La ers
El Beef Feeder
Boars
❑ Pullets
❑Beef Brood Cow
❑ Turkeys
er
❑
TurkeyPou Its
FIE] Other
❑
Other
Number of Structures:
Dischaar es & Stream Impacts
/No❑
I. Is any discharge observed from any part of the operation'?
❑ Yes
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑
❑ NA
[I NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

r
F-Aility Number: 61— Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure Structure 2 Structure 3 Structure 4
Identifier: Li
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'jam
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 LI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes d4o ❑ NA ❑ NE
❑ Yes EYNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes jNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes In No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Oo ❑ 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 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [;3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes � o El NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes WNo
o [INA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes ❑ NA ❑ NE
Comments (refer to question #}..Explain any YESanswers andIgori`any recomY mendat�on's orany other comments.
Use drawings of facility to better explain situations.,{use acid�t�onal pages. as necessary,) =�h;,
Reviewer/Ins pector Name �
_ /��_ >J�(�
�t °� '® Phone:
� ,
Reviewer/Inspector Signature:
Date: 1LiAb
1 12128104 C6ntinued

[F�cility Number: Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ W­Up ❑ Checklists ❑ Design ❑Maps ,❑ Other
❑ Yes E No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
/
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Zo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
FNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E 31No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes2/No
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
L/1 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
IJ 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
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
7�4
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Zo
❑ NA
❑ NE
12128104

Type of Visit Co pllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 24 0 9 Arrival Time: 3y Departure Time: County: 0A8LQiJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: e l Title: Phone No:
Onsite Representative: ' I r'P ✓^�� Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 0fid Longitude: 0 ° = ` 0 i4
Design 'Current
Swine Cap ity Poput, la ion
Design
Wet Poultry Capacity
Current
Population Cattle
Design Current
Ca . net Population
El Wean to Finish
❑ Layer
ElDai Cow
El Wean to Feeder
ElNon-La er'
❑ DairyCalf
El Feeder to Finish
Dry Poultry
El ElHeifer
El D Cow
ElNon-Dairy
Farrow to Wean
'? U
El Farrow to Feeder
❑ La ers
El Farrow to Finish
El Beef Stocker
❑Non -La ers
❑ Gilts
El Feeder
El Pullets
❑ Boars
❑ Beef Brood Cow
El
❑ Turkeys
Other
Number of Structures:
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
21 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
YN,
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Wro
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: ? — Date of Inspection (2 0
A
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 [DNA ❑NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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 o ElNA ❑ 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 ElYes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
•10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes iNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[I NA
ZZo
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
IJ ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 N [I NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No ❑ NA
❑ NE
Reviewer/Inspector Name
��Ph
Reviewer/Inspector Signature:
Pave 2 of .3
Date: f
12128104
ued

Facility Number: _ Date of Inspection l 2
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes (�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
/7�40
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[Z/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ILJ 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
o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
7No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
dNo
❑ 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
{LJ N
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Cortirrieiits hiid/t►r Drarvin s ,- r `§
�z s i N l `t
tom. t t a' § ; : a^5
Page 3 of 3 12128104

6q
Type of Visit
Copliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Dented Access
Date of Visit: I Y 12 Arrival Time: b U d Departure Time: County: 6A1S to b Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: eaxw&
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
SNCfeAko
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = & Longitude: = ° ='
=
Design Current
Design Current
Design Current
Swine Capacity PopulationffW�et
Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
er
❑ Dai Cow
❑ Wean to Feeder
n-La er
El Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
® Farrow to Wean
O
77
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Aullets ke
❑ Turs
❑ Beef Stocker
El Beef Feeder
ElBeef Brood Cow
❑ Gilts
El Boars
Other
❑ Other
❑Turke Points
❑ Other
Number of Structures:
Discharges & Stream Imvacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [a'N ❑ NA ❑ NE
❑ Yes �J No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 6 Date of Inspection o
Aste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA 0 NE
Structure Structure 2 Structure 3 Structure 4 Structure 5
LA-r,-,v)
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[Z� o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElYes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Ye7No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNA
❑ 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 Dyes
3No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
/No ❑ NA ❑ NE
maintenance/improvement?
1 I . 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 Drib ❑ 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 UN El NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes No ❑ NA ❑ NE
t6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes E No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
D N
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name d%i V ti r ., _' '; Phone: j►D % 3
Reviewer/Inspector Signature: Date: do
11/72in11
­6 . d

Facility Number: 6� Date of Inspection ?. b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes
u o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
21 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
fo
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
<o
❑ 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
En No
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
E1No
❑ 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
0 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
El Yes
�,/
OINK
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
7No
❑ NA
❑ NE
Additional Comr ments'and/6r Drawin s ;
Page 3 of 3 12128104
Page 3 of 3 12128104

Facility Number SG
i:
Division of Water Quality
Q Division of Soil and Water. Conservation
o,
Other Agency:
Type of Visit Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: 2 o% Arrival Time: 1 8: YT-1 Departure Time: County: °/✓St.onJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: Pkill;12 Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 4 = 4, Longitude: 0 0 01 0 1
a.
Design Current. De'stgn, Currenta, Design; Current
Capacity Population Wet Poultry I Capacity Population Cattle °Capacity Population'''`
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
©Farrow to Wean
I IS U
7 S
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other `
❑ Layer
❑ Non -Layer
`Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
❑ Dairy Cow
E]Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures -: aC
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes el/No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ElNA
ElNE
❑ Yes
❑ Yes
❑ NA
❑ NE
El Yes
VNo❑ NA
❑ NE
12128104 Continued

Facility Number: to -- SG Date of Inspection 4 0
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: (AG OOd
Spillway?:
Designed Freeboard (in): 20
Observed Freeboard (in):
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 LQ No ❑ NA ❑ NE
❑ Yes ENo ❑ 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 [2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [jNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes YNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�{
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ 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
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
L�J No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[,Io
❑ 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):
C.C.
�t.� NEExJ SaLL S-A ^AP LC 0014E
S�N+� CAPrES' Tv O�1Q t.�Sx.w.Ss�}!�"t—af.}
Reviewer/Inspector Name - -- — -- T �a l.! Tp t;( �� - Phone: �S►b 7 c% (, 4 7 3
Reviewer/Inspector Signature: Date: 4 O 7
Page 2 of 3 V 12128104 Continued

•
Faei;ity Number: — Date of Inspection 1
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. ❑p ❑Checklists VY ❑ Design ❑Maps ❑Other
Yes ❑ No ❑ NA ❑ NE
❑ Yes C�No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box b low.
es
❑ No
❑ NA
❑ NE
El Waste Application El Weekly Freeboard [I Waste Analysis ail 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
ff'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EiNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dN o
❑ 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
eNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ql o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
L7 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
//
D<o
❑ 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
M,�,</o
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
la'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of'Water Quality
FAcilityNtimberl 61 SG O Division of,Soil and Water Conservation
Q Other Agency
Type of Visit cp pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ?J 9 Arrival Time: Departure Time: County: 04"" Mj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: j A C k. 14 L B Ott
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: E=] o = ' = Longitude: = 0 0 ' =
Design Current Design_ Current :'. Design Current
Swine. Capacity Population Wet Poultry Capacity Population Cattle Capacity"Population
❑ Wean to Finish 7 10 Layer �
❑ Wean to Feeder 10Non-Layer
❑ Feeder to Finish
® Farrow to Wean1 Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
`Other
❑ Other f
❑ LAY ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures.
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 1344 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes L'N ElNA ElNE
ElYes Eo ❑ NA ❑ NE
12128104 Continued

f
Fgoity Number: G7 _ SG 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 l Structure 2 Structure 3 Structure 4
Identifier: LXC"V
Spillway?:
Designed Freeboard (in): 714
Observed Freeboard (in): 3` 1
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 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes WNo
o ElNA ElNE
$. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑
9. Does any part of the waste management system other than the waste structures require ❑ Yes IJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [T No ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? if yes, check the appropriate box below. Cl Yes 0No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1_TNo
❑ 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
d o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other..comments.
Use drawings of facilityto better explain situations..(use additional pages as necessary):"
I S� eeMoee 040 XTAL- S RlLt r I f L
14) rAAM f 6A- G"<p
Reviewer/Inspector Name — - —hl jQrL3J(�}l�[, l Phone Q�� 7
Reviewer/Inspector Signature: Date: llzNot.
Page 2 of 3 12128104 Continued

t
0acility Number: — Date of Inspection I q 'ujjV
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. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Wee y Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Yes JW❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
0/Yes ❑ No ❑ NA ❑ NE
❑ 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
L/J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(No
❑ N
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
LdNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑zo
n NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ld
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
LEA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ 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
P Nc
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�</o
❑ 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
D4,
❑ NA
❑ NE
Zo
33.
Does facility require a follow-up visit by same agency?
❑ Yes
L
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

R � Dr ision of Water Quality
r==Eaci1it,yAtnber 697 _ �(p _ O Division Qf Soil and Water Conservation
--� 11141101 %gq Z,
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q/Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I VA2/951 Arrival Time: Departure Time: f fl0 County: ONSLo!a)_ Region;
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:yACAL rtAt_{3Edl.`r
Certified Operator:
Back-up Operator: � y i A e.r qzr
Owner Email:
Phone:
Phone No.
integrator: M U2Pla4e ___...
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 0 « Longitude: 0 ° =' =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
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 Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters ofthe State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ o
❑ Yes
L' I No
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
12128104 Continued

Facility Number: (o I — 6 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: C. AG00P-�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 E�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2fNo ❑ NA ❑ NE
Cl Yes dNo ❑ 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 16No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Croptype(s) - R'5 C'VL L,N ) I641.M �r ,�, W,J.
13.
SoiItype(s) Foa-es-ro0
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?
0'Yes
[:] No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
L' I 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
E�No
❑ NA
❑ NE
f 5,) �.Lps
►Jc-_c n ��r� �� art
t�.�
w Zr I(
SOU Art o W p1-T f l L 6iL O T C A DJG ,tj�
RE(-c.� i-n Q e
usr✓ici
vPDATE MAP
w-Tru PuLt✓S ANp t„,)UP,
�(LAYV` 0 C.T.
IZ401-4
ra NC� LJ FGa,►n�_.s tj f)
I✓ ?+=`az.M T
Reviewer/Inspector
Name"
�s�l;° A:'�a. ��� ,�pka;�� Phone: q1b
Reviewer/Inspector
Signature:
_ _ Date:
31t,L/j.
12128104 Continued

11
Facility Number: Date of Inspection 3
*�equired 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 appropiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �dNo ❑ 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 ZNA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes El No [:J IA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes LZNo ❑NA El NE.
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ f
No LI 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 VNo ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes L ry ❑ NA El 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 YesjNo
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 El El NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ NA ❑ NE
� P � Y� .5�., k. i. P•i Y. „ fK 9 ti� ir-" �
� 4 i+.� 'i :F T + '�%'+ �1`s` 'si i . �a - ,{ [�, t.y � k ,
12128104

Type of Visit O Compliance Inspection Q Operation Review 91'Lagoon Evaluation
Reason for Visit O Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: Time:
0 Not Operational 0 Below Threshold
[j ermitted Certifired i©Conditiaaally Certified Registered Date Last Operated or Above Thrr hold: .........................
Farm Name: ..........Gi (k.L....i.....,4Y.,t,G......................................................... County:.{...`i.,Cl�x........... .......................
OwnerName: ................................................... ....................................................... ................ Phone No:.......................................................................................
MailingAddress: ............................................................. . ............................................... ...... ..................................................................................... ..........................
FacilityContact: .............................................................................. Title: ..... ................................................... ........ Phone No:...................................................
OnsiteRepresentative: ........................................................................................................... Integrator:......................................................................................
Certified Operator:................................................................................................................ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° " Longitude ' 4 44
Discharges & Stream IrnPacts
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)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identificr:........................................... . ......................................................................................................... .......
........................
Freeboard (inches): Z�
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
12112103 Continued

Facility Number: — Z6 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ 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
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor lrsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
0 Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
Field Conv ❑ Final Notes
G-�� was
beEf? G�Rsylfl�ep� 7'� /�reuP.�e T orj�-'S/%,
- wo�,(%r is u� Ewa sic �c,�:n � /a1a�
Reviewer/Inspector Name t"
Reviewer/Inspector Signature:
Date:
12/12/al

'Permitted 0 Certified [3 ConditionallCertified © Registered
FarmName: ......4.4.c.. .................................................
OwnerName: ................ .�................................................
MailingAddress: .....................................................................................................................
Facility Contact:
Title:
Onsite Representative: ...% .............1xt" (Z. �> ...........................
Certified Operator:
Location of Farm:
Time:,30
Date Last Operated or Above Threshold: .,
County: .... &516P14i......................
Phone No:
.................................. P onne No:............ ..............................
Integrator:... 1t.j�:�`' l.J/CJ...........
Operator Certification Number:
JM Swine ❑ 'Poultry ❑ Cattle ❑ Horse Latitude Longitude • ��s
Discharges & Stream lmbacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2 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)
c. If discharge is observed, what is the estimated flow in gallmin?
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
StruuIture 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............................................................. ........ ................... .......... ..... ................................... . «
Freeboard (inches):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 21�o
❑ Yes 00
❑ Yes RVo
Structure 6
12112103 Continued

FacilAv Number: 6 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes '440
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes �' o
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 C3`No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes E;K0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ;R'No
elevation markings?
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Ofio
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ;24o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those'cle"sFgnated in the Certified Animal Vtste4anagement Plan (CAWMP)? ❑ Yes �Vo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes P'1q0
b) Does the facility need a wettable acre determination? ❑ Yes ,ErNo
c) This facility is pended for a wettable acre determination? ❑ Yes PNo
15. Does the receiving crop need improvement? ❑ Yes ,ONo
16, is there a lack of adequate waste application equipment? ❑ Yes Eldqo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes '12Ko
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes eo
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.
Revieweranspector Name
Field CODY ❑ Final Notes
Reviewer/Inspector Signature:
Date:
12112103 Continued

: Faciedy Number: .. Date of inspection G
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMF?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ YesH<o
❑ Yes Oio
❑ Yes PrNo
❑ Yes
P No
❑ Yes
P-Po
❑ Yes
04
❑ Yes
;9140
❑ Yes
O"No
❑ Yes
E�No
❑ Yes ;2&0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ I20 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ab 1%Se_ �j� o?LI)03 layacy, e-,
-A �710 O -'?G 0 `� C 70 e�//vr 1�`oL✓/anal v✓
,,;-h,4, 61WO
1191eaS2 do S ��e cue Co r�eGT �%
CX
R11clo c, /, ; 4 311. f /-,
a?e rl ram/ ,, V 4rlc2.S 6-e,,1I1'/, sY's- _
12112103

Facility Number Date of Visit: Time: i=
Not O erational Q Below Threshold
© Permitted 0 qertified 0 Conditionally Certified © Registered Date Last Operated or A K
ve Threshold:
Farm Name: �1 `��� S�—---__-- - County: C+L--,,
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:,�4y
Certified Operator:
Location of Farm:
Phone No:
Phone ffNo.
Integrator: �1t
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 11 Longitude C�• 6 14
Design . Current
Swine Caeaeftj Po ulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
P ultry Ca aei Po ulation Cattle :.. Capacity Population
❑ Layer I Fol
Dairy
❑ Non -Layer on -Dairy
❑ Other I I I
Total Design Capacity
Number of Lagoons 10 Subsurface Drains P
aiding"�Pon.6 [SAd 'Traps � ❑ No Liquid Waste MF
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?
Total SSLW
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):
05103101
J Spray Field Area I
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure G
Continued

Facility dumber:j?j — M Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
M`aste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAIA'MP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage &: General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DVVQ 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 AVVNIP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes [:]No
LNo violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
r�''-..al4wii*.�lkrSb'J!'INY �
Comihents;(refer`to-queiddii: #)..E plaiii.anyf YFS acesweirs and/or: an,rrecommenda�o os nr�.any oth mmenta %i
' "9 ° ❑ Field Copy ❑ Final Notes_....-.
Use drawings of fncili to better a lath sttuahons . use addEttopalVag, es as rtecessa F
a t?'E rp �.. ( , i" o i ry)1
- ur t� 1� Ew
keiAA+r==11sc�+� —
,i>kt k:,1°;$,,.:µ:1u�c..F:,.fc.4s,Y'.ta%i�`Mt.�E±iiia.^.?- ,.klili. "•:UE'4,�,f@Lekiba.i:M.si1crL_zL--
G S G <M— L Q 44-t. 4 �� & yla",
c
ar ��+c, a� a � lL• c�r�l«,
Reviewer/Inspector Name '-y�
Reviewer/Inspector Signature: Date:
05103101 Continued

I
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint 0 Follow up ()Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 00 Time: I q 7 so
Not Operational 0 Below Threshold
©Permitted O Certified ©Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: Tq j e +� T' County: lr1 S 1t+GV
Owner Name: C i A %4: Phone No:
Mailing Address:
Facility Contact:
Onsite Representative: E^� Ti.11 ber
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 44 Longitude 0 6 �u
Design Current Design Current Design. Current
Swine Capacity Population Poultry Capacitv Population— Cattle Capacity Population
❑ Wean to Feeder 10 Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non Dai
❑ Farrow to Wean - -
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity l
❑ Gilts E
❑ Boars Total SSLW
h ' g ° 1 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
g use >
Number of -La oi} -
Holdin Funds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges _& StreamImpacts
1. Is any discharge observed from any part of the operation? ❑ yes ONo
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? (1 f yes, notify DWQ) [] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2, Is there evidence of past discharge from any part of the operation? ❑ Yes 'zNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes j2rNo
Way
to Collection 8& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes /zTNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches): 2-3
09103101 Continued

l '
Facility Number: — S Date of Inspection J 3 0
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 property addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9: Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Pon�d1ing ❑ PAN ❑ Hydraulic Overload
12. Crop type FC- se ve Ha �! _ � ' •``� a 4
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?
Reguired. Reg2rd§ & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
❑ Yes &No
❑ Yes gfNo
❑ Yes ,ZfNo
❑ Yes ;d No
❑ Yes ONO
❑ Yes ONO
❑ Yes No
❑ Yes No
❑ Yes ZNo
❑ Yes 12'No
❑ Yes No
Cl Yes No
❑ Yes �No
❑ Yes 2/ No
❑ Yes ErNo
❑ Yes ANo
❑ Yes EfNo
❑ Yes gNo
❑ Yes ONO
❑ Yes &No
❑ Yes SAo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments' refertb �Y3>,. trkA y;
""� `l( question #): Explain iiny YES -answers and/or4,any R"iftendationsof:any other
Use drawings of facility to better explain situations: (use,additional pages as necessary) [] Field Copy ❑Final Notes
, ; a . M a
e �a �.h� �c ce �d si q n al Gros A.-e kve ll rvt A -4,q in e U1 . `77-.m a k
Y0bA ire � � a 0 e4fel
r
Reviewerlinspector Name � �Oh t:�✓ A�%, ly+ f " ; , ;
Reviewer/Inspector Signature: Date: .3 3 143
05103101 Continued

12
0-
Facility Number: CZ —576, Date of Inspection 3 /3
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ONO
❑ Yes -�O
❑ Yes 2No
❑ Yes J2 No
❑ Yes ,E:rNo
❑ Yes ETNo
❑ Yes LINO
Additional Comments and/orMta►vings:
7
i
T
05103101

l
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit of Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit, 11 d 2 Time:
E: Facility Number S
10 Not O erati nal Below Threshold
©Permitted © Cer'tified?? E3 Conditionally Certified D Registered Date Last Operated or Above Threshold -
Farm Name: a� b'z - � i �County: 9*1's- ]b4✓
Owner Name: & 1c _7'�ti I b 'C 'L Phone No:
Mailing Address:
Facility Contact: 'Title: Phone No::
Onsite Representative: C 7-4 1 ��T,. {✓ C*1 .T A1c-/ ) l ntegrator: � lJ y ►/'�-�-s —�i' a i-✓''�
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �• Du Longitude 00 •�
;' .: ` ©esign
Current " ` :Design
Currept 7
�.
Design,, ; Current
Swine Ca 0aeiti•...Pa ulsthon._ °Poultr Cu achy
Po, tilation Xattle _ :�: , Ca �acitv,�'=Po 'iiiatiou , ,
❑ Wean to Feeder
"" ❑ Layer I
❑ Dai
El Feeder to Finish
}.
; ❑ Non -La -Layer
1 ` ❑Non -Dairy
❑ Farrow to Wean
Farrow to Feeder
❑ Other
❑ Farrow to Finish
TofaF besign CpaCtty
❑
Gilts
[] Boars
(�Q
Total SS LW
Number of Lagoons , ",
° ' ❑ Subsurface Drains Present jF0LgoArea
10 S rav Field Area
,Bolding'Ponds.l:Sohd;Traps
€F ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other /
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2, Is there evidence of past discharge from any part of the operation? ❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ YesJ?�No
Wa to CgAgglion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ',Z'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Freeboard (inches): Z 3
05103101 Continued

ti
Facility Number: 1.7 — 6 Date of Inspection �
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes O'No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
ffNo
closure plan?
(If any of questions 4-6was answered yes, and the situation poses an
❑ Yes
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes j2rNo
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 j[ZNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes Zf No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes "En No
12. Crop type 49er d �'g e,r G v P
13. Do the receiving crops differ with those designated in the Certified Anima astc Management Plan (CAWMP)?
❑ Yes ONo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ;ffNo
b) Does the facility need a wettable acre determination?
❑ Yes ,rNo
c) This facility is pended for a wettable acre determination?
❑ Yes Z No
15. Does the receiving crop need improvement?
❑ Yes ONo
16. is there a lack of adequate waste application equipment?
❑ Yes ,fNo
RRe uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ZNo
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 Z No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes WNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes JZNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ZNo
24. Does facility require a follow-up visit by same agency?
❑ Yes P110
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ONO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
Comments (refer to question #) °Explain any, ICES answers and/or any recommendations or anv;other,comments: J
—. 3
{-t G i Z
Ilse drawings of facility to better exptatn situations. (ase addigonal pages as eecessary) [ Field Conv ❑ Final Notes
eda1. , ,� ,.r71r�nmrrrr.nr+.....e<.<.....�.+>>>..,.r4«.mt'rrm:,r
. 4 ¢,<,d1.�.e
s ���S be �n9 i.��rr rn� i►'t��+v�Go�. �+-�c be w,.vdG 4�-
�'rra�° ;s w�11 es�q 6?;sL,�it �►�Ql -���
ice SG�e �aS b�er� /'e-r6a {CA - 4r4AP d is er"ey i
-T� bl e G r e q ✓k P( 1 G►S re 1.✓ el!
+; S w n C e c,S q q c
Le, y'oc and s qre wall k.��� qnd ;�, o.aDr D✓DIPrI�Qyt��
H,
Y
�.. (f ;.� {� �F .. 7.E
Reviewer/Inspector Name , _ ..
dip
Reviewer/Inspector Signature: Date: 2 O
05103101 Continued

Facility dumber: 617—$6 Date of Inspection I D
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes P"o
❑ Yes -0 No
❑ Yes 'zNo
❑ Yes J0,No
❑ Yes ONo
❑ Yes ❑ No
Additional Comments as /or' raWin&
C �� Ike wa 3 �a Sa ►^�� d e s a vt � kccv e G h 4
f�
Coh st�fP �r_A �G kCs
,SL c k 4.44� e �R V L✓4sje +z Q l y s� S rej U))
�o �l�t s rs� ,1� //'c-Cj41as,.5I AAnd vse
w t�. � � Yi 11
a Y. -k e :r d)(-- `Z .� -�� Gq I e-,1%,1 T e P# nl o% e f b a p/
—FJE le 6 y6 e��, j $ 5 `I or e, -+' -Far t I S t-.,r.P. Q/z i 11 7— -
AA%A 4kewell I<e f4) t n'y eV;rg1-Jr 40
i rt �at ►t 44 e ?Gt ✓'"t ' t., goer e v iW e ✓3 4 ei n d
gt�plG�GtGZ-G4j. 41se, klo4e, 7Lte ��SDOr. �y'cc.aa►sD� w.aS
05103101

Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit )0 Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of visit: Time: �U
� Not O erational Q Below Threshold
Permitted [3 Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold :.........................
Farm Name: �ot..� County:....G� Lj........................................ ............
...................................................................................... ......
OwnerName: ................................................................................................................... Phone No:.......................................................................................
FacilityContact: ............................................................................. ..Title: ............................................................... Phone No:....................................................
MailingAddress: ........................'_...................................::.:........................1.....................................................
✓�s- �..........................................
Onsite Representative...................................1..fa \...................................................... Integrator ...��r-hSi..................................................
Certified Operator: .................................................. ........... Operator Certification Number:
................................................... .........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 9 • '° Longitude 0 4 «
Design . Current
Swine Canacitv Pouulation
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer 10 Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity
T&A SSLW.
Number of Lagoons E ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps'' ` s ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �fNo
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? (Iiyes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated now in gal/min?
d. Does discharge bypass a lagoon system? (Tf yes. notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes �rNo
S, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes $�[No
01/01/01 Continued

Facility Number: 6n --
Date of Inspection 'Fii
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ................................ ..........................................
In n
Frecboard (inches): ......
El Yes X No
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
qNo
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
❑Yes
�No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
V No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
9No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
NfNo
11. Is there evidenc of over ap Iication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
_No
12. Crap
type C.G�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
15?(No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
t No
b) Does the facility need a wettable acre determination?
❑ Yes
)J No
c) This facility is pended for a wettable acre determination?
❑ Yes
lEfNo
15. Does the receiving crop need improvement?
XYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ZNo
17.
Are rock outcrops present?
❑ Yes
❑ No
18.
Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
[:]No
❑ On -site ❑ Off -site
Reyuired Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
XNo
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONO
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
Cl Yes
ONO
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
A No
(ie/ discharge, freeboard problems, over application)
❑
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
I$No
26.
Does facility require a follow-up visit by same agency?
❑ Yes
�TNo
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
W'No
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
14 No
01/01/01
Continued

'w
Facility Number: —lj� Date of Inspection
Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes PrNo
❑ Yes t<No
❑ Yes WNo
❑ Yes q No
❑ Yes nNo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
1SG UIUWMA 6.l Ul LMLIM.Y LV LPVLLCE V1AJJ#a1AUa]tUaLJUJW kUaC: "UUBWV1MaJ k/ilb'G1'ilJ 1lGlA,tal]f" }}V er a u
'r ❑Field Co �/ Final Notes �{f
ef'�kCr, Rcr' i} e I ry pJ , �xi �,'i-✓
,aEi �> ..,�"„1,,��Y,.�9,
(�A� Ar' jca-�"-Q- - Q,' Q4
�; t,��.,,�,1'-O— — •� CSC" ��t.Q 1 c3 {�. T�c3 a.-��c•-_
`5
01/01/01

Division of Water Quality
Q 'Divi
sion of Soil and Water Conservation ,„, ,
Q Other Agency
Type of Visit I%Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date, of Visit: Time: © Primed on: 7/21/2000
O Not Operational Q Below Threshold
Permitted © Certified Conditionally Certified [a Registered Date last Operated or Above Threshold:
`� 1 +.— Count
Farm Name: .........1�1\1............................................................................................. G.�,1.............
OwnerName .......................................................................... Phone No:........,..............................................................................
FacilityContact: .............................................................................. •title:................................................................ Phone No
Mailing Address:............................`.............................. .......................I�vrr
............. .........................................................G.................
Onsite Re )resentative• .Integrator:
................................................................... ..................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:...................................
Location of Farm:
I�
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' ��� Longitude •
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non-Dairyl.
Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JEJ Spray Field Area
Holding Ponds / Solid Traps JE1 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, nolily DWQ)
c. If discharge is observed. what is the cstimatcd flow in gal/milt?
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 ce Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
SU'ucturc I Stl'nCIUre 2 StrUClUre 3 Structure 4
Identifier: ....................................................................................................................... ........................
Frechoard (inches): 3a
5100
Struclre 5
❑ Yes O(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes f(No
Structure 6
Continued on back

Facility Number: — Date of luspcction Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 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
gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
Cl Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
KYes
❑ No
elevation markings`?
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
kNo
11. Is there evidence of ov application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
XNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�(No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
14No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
e) 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
WNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
[kfqo
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? (ic/ 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
No
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
E�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application) ❑ Yes gNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes No
24. Does facility require a follow-up visit by same agency'? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 2�No
�i '.00a�iOtis;or• iieficiencies •were h6ce . ilurir. 9 4i'tis'visit' • :Y:oit 'Will •reeeiye •tio further:
corres�ondeitce. about. this visit
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A.
9)
LA
2N�
s, Mgt T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: g 31•-0o 5100

Facility Number: — 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 ❑ Yes P(No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28,
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
(INo
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 fecd 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
Q No
40 5S�� k" �Z�r
4(3
0i
dK, r
L�Saa ►-� � �vC� ace �re.� �S d �.

F k O
Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number�� -
Farm Name:
On -Site Representative: r
InspectorlReviewer's Name:
Date of site visit: —(q— (3
Date of most recent WUP:
Annual farm PAN deficit: pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility item(s) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
'J Operation pended for wettable acre
determination based on e P2 P3 .
Irrigation System(s) - circle #: 1. hard -nose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe stationary sprinkler system w/portable pipe;
6. stationary gun system w/p'ermanent pipe; 7.-stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D)D, irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, 'including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational .table in Part III).
PART 11.75% Rule -Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination .required .because.operation fails Dn_ e of the .eligibility
requirements listedbelow:
F1 Lack. of�2creage:which-resultedin:over�pplication:0f Wastewater -(PAN) on:spray.
fields) :accordingfofarm'sdasttwovears :Dfirrigabon7ecords.-:
F2 Unclearjllegible,-or lack of-informationlmap.
1
F3 Obvious feld'iimitations-(numerous:ditches;failureto:deductTequired:...
buffer/setback-acreage;-or25%--ofIota l:acreageadentmeddn-LAWMR.71ndudes: _
small;-irregulady-shaped fields = fielesJessthan-5 mcresfor#ravelers or..lessthan
2 acres for. -stationary -sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised April 20, 1999
Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP
NUMBER NUMBER"2 IRRIGATION ACRES ACRES
SYSTEM
FIELD
%
COMMENTS'
j'
Q,.3.83 OTA
I I I I
I I +
T I
I I I 7I 1
1 I
I I
FIELD NUMBER' - hydrant, pull, zone, or:point numbers Tnay be used in place of field numbers depending on CAWMP
and type of irrication-system., If pulls, etc. crossTnore-than one field, inspectodreviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER2 - must be clearly delineated nnmap.
_-
COMMENTS'- back-up fields with CAWMP acFeage:exceeding75% of its total.acres and havingreceived less than 50%
of its annual PAN as documented in the farm'sprevious:twoyears' (1997 &.999B) of irrigationTecords,-cannot serve•as•the
sole basis-forrequiring a WA Determination::Back-up:fields-must-be-noted in the -cornment:3ectionznd musthe accessible
by irrigation system.
Part'IV. Pending WA Determinations -
Pi Planlacks.followinginformabon:
-L,�� C", �in= �,� 2t;2
PZ Plan Tevision -may:sabsfy-75% rule based on adequate overall PAN deficit -and by
adjusting all field :acreageJo below 75% use rate
P3 Other (ielin process of installing new irrigation system):_

V/
Lagoon Dike Inspection Report
Name of Farm / Facility Jack T 6 - 56
Location of Farm / Facility 5R 1146 .
Owner's Name, Address lack Ldbert,_G68 Hughes Road, HamI25tead.
and Telephone Number -MC —Z84A3- 910-27Q-3 5 10
Date of Inspection _ 127199 Names of Inspectors Zahid Khan
Vincent Luda_
Structural Height, Feet
Lagoon Surface Area, Sq. Ft.
Upstream Slope, aH: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 )
6-8 Freeboard, Feet 1.0 -_ 1.1
1 _OS 00 _ Top Width, Feet 10 - 12
Downstream Slope, aH:ly 4 to 1
Yes _- — No
Yes _X No
Yes X No
—Venr�&nor Erosion in Dommstrearn
Did Dike Overtop? Yes _- - No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes _ X - No
Engineering Study Needed? Yes _X_ No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X_ No
Other Comments _ Talked with Mike who works for owner.

S z 0 Division of Soil 'and' Water Conservation U eratioii ReviewEE y i I:
¢tl p r
jr in I E € € k€ !n€ Division Of il� OIl aOdl Water r.OlLSCCVa _oII Compliance .Itnspection €}�I' 3
DiVisiOi7 Of Water Qu'ahty ;Cainp
ltance Iil"
is eCtlOn tr �t i{€; f t i €6! €, ( C �y'€p y €,J3 § i K aia
;i, { is ',J. i�[,
Other A, en �O eratloil.HeV1eW t;', { €! ty € t' €
g.: y_ P.. € €g 'I = E s r i {i.r t ,S
.. 'd.e ��-,. ..... .. ,., e!i__ F 3
Routine OComplaint Q Follow-up of DWQ inspection
O Follow-tiof DSWC review Q Other
Facility Number
Date of Inspection
Time of Inspection O 124 hr. (hh:mm)
Permitted © Certified Q Conditionally Certified
Q Registered
Not Operational Date Last Operated: ..........................
lt+�t.-
��.1..........
County:...
Farm Name: ,.1�� .
.............. Lam!. ..................
Owner Name :............................. .............................................................................................
Phone No .��d�„l.r� 1 .,....................................
.,....
FacilityContact:..............................................................................
Title:................................................................ Phone No: ... ................................................
,Mailing Address: .............................................
Onsite Representative: �...................................................
.................................... ............ ......................
Integrator* C
.�'- ......
..........................................................................
1, ......�.....��. ....................... ....................
Certified Operator: ................................................... .............................................................
Operator Certification Number:..........................................
Location of Farm:
i
.................................... ................................................................................................................................... ................ T
Latitude E= • ' =I, Longitude • =' ="
'lk r Design Current I -1 '� i Design Current' '�Design Current
r € €
Swine € rl!�, Ca acit Po elation Poultry ,, Ca .'acity Po J elation Cattle'Ca 'Capacity elation,, r
[� Wean to Feeder ❑Layer ❑Dairy
❑ Feeder to Finish ❑Nun -Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design. Capacity
❑ Gilts €
❑Boars Total SSLW
Number of Lagoons - fE ❑ Subsurface Drains Present 110 Lagoon Area ❑ y Field SpinArea
l P
Holding Ponds'/ Solid' Traps 0 I ❑ No Liquid Waste Management System
„
i» i
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes nNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes J(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway MYes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identi Fier: qq
Freeboard(inches): ........... 9.......................................................................................................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 15 No
Continued on back
3/23/99

Facility Number. — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
WNo
(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
E%No
8. Does any part of the waste management system other than waste structures require maintenatce/improvement?
❑ Yes
Dd*No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level.
elevation markings?
❑ Yes
gNo
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
Q�Vo
11. Is there evidence of application? ❑ Excessive Ponding ❑ PAN
❑ Yes
�fo
12. Crop type UN Tv�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
CKNo
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?
14 Yes
❑ No
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
5mo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Platt readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
N'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
RrNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
('No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
r( No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9No
24. Does facility require a follow-up visit by same agency?
❑ Yes
ft�' No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
UNo
10 yiolatigtis'Or, dfficWndc sire hO ed. Ooijng �his'visit. • Y:oiz} will-reeoiye 06 fu>G'ftf
correspondence. about. this visit.
Comments {refer46 question #) Explain any YES answers nndlor;'any recommendations or:any other cainitnents �,n ' l t
Use drawings of facility to;:better'exp[ain'situations (use,addetional,pages as niecessary)�gY�E; �<<
%'
e�� �WCx �.��< <e�, a �►�,s�ess A't
1��2� c►— Sc7 ,
Reviewer/Inspector Name..
Reviewer/Inspector Signature: �� Date:
3/23/99

f
-Facili4y Number: — Date of Inspection
Odor Issuer �`-
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes-WNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes M/No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1No
roads, building structure, and/or public property) 11
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 P 'No
`
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ``r0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
1Additional Comments and/or Drawings:, Li" i 1, + � j + ,1: �� _p j` -� � -� • ,
1 ✓ \ ice-- VriC.-V �j
3/23/99

- ...�."'+,..5.�.`° 'w,.., w;'"' r''' , h r �>
❑ Division of Sol[ and Water Conservation 0 Other
. Quality
�
Division of Water Q
Routine O Complaint O Fallow-un of DWO inSDeCtion O Follow-ua of I)SWC review O Other
Date of inspection
Facility Number
Time of Inspection S~ 24 hr. (hh:mm)
© Registered Certified (a Applied for Permit U Permitted 113 Not Operational I Date Last Operated:
Farm Name: (j.... L..................... .<!!....... D1 U' ..
..............�!:..�.. �......----......---............... county:......�...................................................................
Owner Name....... ....................... ....1"_A 1.!�.L.Af1- Phone No: �7r�.... .��...................................
............................... .................
Facility Contact: .... i4og........... Ta.k.99....... Title: ....... 0..w ` Lj..+�............................. Phone No:...................................................
MailingAddress* ....... 41.Qy........ ............................................ ........N.............................
Onsite Representativeiti!�' ..+`!.f.... Integrator:..... C°,�,e�,t?.<. f .5...... ........
....................... .............. ...............................
Certified Operator..�t ��:.. .. p n...�....................�>�::L.��.�......................... O orator Certification Number:.........................................
Location of Farm:
Latitude ` ' 46 Longitude 0' ' 46
Destgn
Current
;ID Current
- Design 'Cur
Swine
PopulafionPaultr'y,
Population
Cattle,>Capac�ty�,I'oputation�
Q
,,Capactty,
,Capac_ity
❑ Layer
❑ Non -Layer
" ❑ Dairy
❑'Non-Dairy
.
h
❑ Wean to Feeder
❑ Feeder to Finish
»�
arrow to Wean
�S
❑Other
z
a
Farrow to Feeder
TOtal DNS1gnCtiaCltj!a$
x•
zTotal SSLWr
a.
❑ Farrow to Finish
❑Gilts
i.-: '❑Boars
<.�
�Jliuirlber of Lagtwrts / Haldtng Ponds
❑Subsurface Drains Present
❑Lagoon Area
❑ Spray
Field Area
." ❑ No Liquid Waste Management System:.;.
»,
n
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
5jNo
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 galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
W No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
P3 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Z No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
10 No
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes JO No
truc ures Lago-onsJ10ding Ponds Flush kits, tc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes U No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
......... ................. ...... ............................. ...................................................................................
Freeboard(ft): .........&...0.................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes IN No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes E'No
12. Do any of the structures need maintenance/improvement? . W'Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ® No
Waste ApRlication
14. Is there physical evidence of over application? ❑ Yes m No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ........................................................... f...)`.................................. .............. ............................. ................................. ...................................
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
[XNo
18.
Does the receiving crop need improvement?
(-Yes
❑ No '
19.
Is there a lack of available waste application equipment?
❑ Yes
O No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
© No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Z No
22.
Does record keeping need improvement?
,Yes
AJo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
JR) No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
.R No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
RNo
0, No.vio'litionsor'deficiencies: we re; noted.dur'izig this:iiisit.. You:wiff receive' ,no.furtlier
correspoideOe about -this'.vWL, ::. .
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IZ7. N i� i7 ra �pa�rs'r f S;Or j /fear �s ry �- �s+s72f jeft f, /Yt /9/!•T f fZ
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: