670065_INSPECTIONS_20171231

NORTH CAROLINA ..�
Department of Environmental Qua

) in
/110=FaCffi-t Number
(Type of Visit: Q Conl Oliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: d Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: JMS"hl Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: y� Title: Phone:
Onsite Representative: ( ��_J\ 46.065 _ Integrator:
Certified Operator: Certification Number: q 9 `I
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Swine
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
er
Dai Calf
Feeder to Finish
Design Current
ltr� Ca aei P■o
jNLa
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
ers
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkey Poults
Other
Discharges and Stream Imuacts
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 rr�No
❑ NA ❑ NE
Yes ❑NA ❑ NE
Yes ❑ 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
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in):
/No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 2 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 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmento threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA [] NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes rNo [DNA ❑ 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 Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/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): .11
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 540 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 40 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes C]�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes C340
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[] Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E Nc ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �To ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
14. Did the facility fail to calibrate waste application equipment as required by the permit. [:]Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 6Yes ❑ No ❑ NA ❑ NE
the„appropriate box(es) below.
[ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a'regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes Cj"No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
[] Yes C:fNo
❑ Yes ]�No
❑ Yes a No
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any othertomments:.'
Use drawings of facility to better explain situations (use additional ages as necessary).
OW V ao 5� C f' Su�1l�, , S� � E _V I4� 4v op y o a ro
Rg I-c,7z $ pJ 6o5 -to OF DzAk.
C1f3. ZOO-. a01 c�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone.�,��� q� —7
Date:
21412011

(01--1
(Type of Visit: (Z) Co liance Inspection Q Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit; ( Koutine O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: g Arrival Time: ® Departure Time: County: (5.QRegion:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: GL'WK) RHODC:S Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm;
Latitude:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
I
JLayer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
QQ
'
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. Pkoult
Ca aei
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turkeys
Other
TurkeX Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
[:]Yes [o ❑ NA [3 NE
[:]Yes 2 No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: (o - S Date of Inspection: 145 jL
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA 6 00, . )
Spillway?: _
Designed Freeboard (in): _
Observed Freeboard (in): 31 _
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?
2/No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes IdNo ❑ NA ❑ NE
❑ Yes ZN o ❑ 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 Z o ❑ 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)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No
❑ NA
❑ NE
❑ Excessive 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?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ;2�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes do
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �o
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[/
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:J�o
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
No
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
C
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[o
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection; ci
24. Did the facility fail to calibrate waste application equipment as required by the permi b ❑YesVNo
❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Zo ❑ 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 E✓ No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes [�r /No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments ..
Un drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: LJ .7* N 1J F'A RJ(-(t _ Phone: % 13g1
Reviewer/Inspector Signature: Date: {p r
Page 3 of 3 21412011

Type of Visit 0
7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I U 3V Departure Time: County: CWSLA%/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
OnsiteRepresentative: iiARSIALL. �►�T(LC-L�- Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I 0 Longitude: = o = 6 ❑ 11
Design Current
Design Current
Design Current
Swine
Capacity Popu�lat� on
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
airyI leifer
❑ Farrow to Wean
Dry 0- It
❑ Da Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑Yes
❑No
❑NA
[3 NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
[I NE
❑ Yes VNo
"❑ NA ❑ NE
El Yes ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 0 - Date of Inspection
Waste Collection & Treatment
4. Is,�torage 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: LAGS*)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1Z
5. Are there any immediate threats to the integrity of any of the structures observed? ElLI 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
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
EA ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[7No ❑ 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
,.,/
ER/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
eNo ❑ 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
3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[B/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L? No
❑ NA
❑ NE
} ii '. ®, :` ? * 3 3 1:'z: `•'-- i .oz ,flk�'s�S1 i i"i�`3N.V!
Comments {refer to,:gueshon'#) Explain as y$YES'answers and/or any�recommendations,or,-any other'comments;
r`'h serawonituue additiiialaes'as necessar �3s `,t 'betts;Umc'
x- ..-... .-.- '„ ., �',._ .. a:. a �# ,•e.`m`r. - .t��k,'l, .:•.'6�,r, e�i ��..^:
C,4G.A►,+ U NE r
S()XVCY Ooho& NEEh TMM5F(:a- To Nee f;,-m. AJ660 go 'To too8 oA)
sI�VOJrrI� . SD I E S7 X ( wykox-P ivr oju (Do.
Reviewer/Inspector Name f — — ,�y�{�, v W� Phone: C 3
Reviewer/Inspector Signature: Date: � 3
Page 2 of 3 12128104 Continued

Faglity Number: `? - 65 Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E;V o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeoine need improvement? If ves. check the appropriate box below, ❑ Yes 0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 3No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZrNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;"Yes
E(No
❑ NA
❑ NE
25, Did the facility fail to conduct a sludge survey as required by the permit?
❑ o
El
[I NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
BNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
YNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EYNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ENo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2No
❑ 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
,.,/
L/J No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
eNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

45
Type of Visit 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: G i og Arrival Time: I I Departure Time: County: 01JSL,6 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone No:
Onsite Representative: Mn 6LjSPAL.t. FO TEE 0— Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 4 = {1 Longitude: = ° = ` = "
Sr►ine
Design
Capacity
t±urrcnt Design Current Design Current
Fopulation Wet Poultry Capacity Popu[ation Cattle Capacity Population
❑ La er :j— iry Cow
❑ Wean to Finish
Wean to Feeder
-Layer
iry Calf
Feeder to Finish
iry Heifer
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑Non -La ers
❑ Pullets ❑Beef Feeder
❑ Beef Brood Cow
❑ Turkeys
IL31 urkex Poults
❑ Other I Number ofitgrfuctum:1111111
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
dNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
6�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
CdNo
❑ NA
❑ NE
other than from a discharge?
' 1
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ 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: (A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �.r3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes FfNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes - No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require El Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o [I NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
Wo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
❑ N ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
t ❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El
No ❑ NA
❑ NE
" �"r��'$�6#+�i �}�9s'"�mf�; � Y s ��'�� * .•rr �; i��C, �r�y L �t�uY�s_° S'M'�,'; i;�£�.'4�'E `T�b � W �#�y"�`£w$�"k &�;�t��:��' � °} ...,, . «., ?4 Y'Y��i�i�i�L �' � � �`y'°"z
Comments(refertoqucston;�#pla,inanyS�an csand/ar. auy recpmme atinus or any other comments., .. . a
Use,,jr�fyawings of f♦sellcty to bettger ex`plaintgsQltuati$nns (use+additionpal pages as riccessajryY)s t RY Fyy '.. " . gh'
i$:s �.K".-Ri�kl_�... ,0. t3 u3� ...�1....�.��•XTL�.1 �.X'.F.+11'�i �:`.� �in2'.I���s.i�Y�x�C���� -�, ��Ai95i851�C'�.l� AH: ♦ '.1�,Yi.F'x n.as _i. :Y��Lv f�6';r9:
ZA01 AhWVAL. AveaACr( 5r6C*_r1JCry
CUDS S� PT 7-aa`� wJ-X_L-,, NOD ro '3
to*Nl't:XAa)OC, fy _�� ,
Reviewer/Inspector Name eJOi� LAL`; Phone: (916 1qG--73K
Reviewer/Inspector Signature: Date: to 11
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. dyes ❑ No ❑ NA ❑ NE
❑ Waste Appliation ❑ Weekly Freeboard El Waste Analysis [3 Soil Analysis El Waste Transfers El 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes , o ❑ NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? �Vyes
es l No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ( No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes diNo ❑ NA ❑ NE
and report the mortality rates that were higher than normal? /
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes C,YN
o El NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yeso ❑ 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 6 o ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes WN o El NA NE
Additional.Comments and/or Dra*ings
Page 3 of 3 12128104

f
Facility Number
V Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Compliance Inspection
0 Op ration Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
V Follow up Q Referral 0 Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: ONSL 0
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: 13%hori (_-(-VxA) tom ILZIntegrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = e 0 I ❑ Longitude: ❑ ° = t ❑ If
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
—�� ❑ Layer
I' JE1 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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
❑
Daity Cow
❑
Dairy Calf
❑
Da(n Heifei
❑
Dry Cow
❑
Non -Dal
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures:
�f
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
r��J,,��No
[I NA
El NE
❑ Yes
LdNo
❑ NA
❑ NE
12128104 Continued

Facility Number: G) — (�S Date of Inspection i S
Waste Collection & Treatment
/ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
1 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: LC7*u .l
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in): q?,+
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
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):
.W) t,AVE Stru06C ?LAO U560-E EiPPL-ZCAT j(jpj oC Sw06E *A) AFM. Li 4;41
+
Z./-La 6'i. '(etJi IU)6- 14AD ?LA.l DONC MAY 'Stu-a7 Oe ovE.n. ►4PPCXcAT24t3
WASTE ANAL f&L5 WAS 3,q Af(VOK14kAiEL-e 4g0000 CAL"05 AfeLTCA vAs c{ Z
PL N 1 Fe t—L o t,.J A 4 0 Co uT4NGj AC 5 L_ U 0 (s6 2EnnvV&V W&W ,
Reviewer/Inspector Name J'uNW .FAaAji t,L Phone: (4Q19(4 -'?3 sW
Reviewer/Inspector Signature: Date:
12178104 Continued

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

Division of Water Quality
Facility Number - is S 0 Division of Soil and Water Conservation
:0 Other Agency.s
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
04outine O Complaint
Q Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: r41,2 Arrival 'lime: J 3 d Departure Time: County: VPJ L4i� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone No:
Onsite Representative: 1y_''AZS14IUAL FU± a2_ l C Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: 0 0 = I Longitude: = ° 0 ' 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -Layer
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turke s
ElTurke
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 Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [!No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2o
❑ NA
❑ NE
❑ Yes
QN-'o
❑ NA
❑ NE
12128104 Continued

Facility Number: I. — (, S Date of Inspection q o
J Waste Collection & Treatment En"
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes En No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA (%'* �
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes 00 o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [3 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes I/J No ❑ NA ❑ NE
maintenance or improvement? ,
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2rNo ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E;rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
�Ko
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
g o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej<o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
,P-S) fix' iz c OPY d I_ RID & E S'O rZ, E Y T6 WZR, 0 O /O
f, vnnl� 1'L Sto ��-
ttL 04 tj UP 6A (JO
Reviewerfinspector Name Phone:
Reviewer/Inspector Signature: Date: 3 d
12128104 Continued

Facility Number: (p — j Date of Inspection
Required Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes [2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Raigfall 2<ocking ❑ 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
►ErNNo
[INA❑
NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ s
9 'No
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No .3NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ 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
Q 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
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
Q-No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LJ�No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit Z Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up eReferral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Z Q Arrival Time: Q Departure Time: County: i✓SGOt{J_ Region:
Farm Name: l— 1/ �% ��2/►'� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: j� Title: 'Phone No:
Onsite Representative:
Certified Operator: Z!l&-4 __ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = I{ Longitude: = ° = d = it
.Design Current
Design C►urrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish `1
❑ DairyHeifer
El Farrow to Wean
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑Non -La Non -Layers
El
❑ Pullets
❑ Turkeys
El Stocker
❑ Beef Feeder
❑Beef Brood Cow
❑ Gilts
❑ Boars
Othe
rkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (Iryes, 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 11 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�] No
❑ NA
❑ NE
❑ Yes
/� No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — 5
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:
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
El Yes //❑ No
Structure 5
❑NA El NE
❑NA ❑NE
Structure 6
❑ Yes No ElNA ❑ NE
ElYes XNo ❑ 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 VNo ❑ 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 El
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ILJ No ElNA [I NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. w'es ❑ 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 WindoV ❑ Evidence of Wind Drift ZApplication Outside of Area _
12. Crop type(s)
13. Soil type(s)
V,4 il ) s. 11'r"- 104 �_ ) 64,11
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
2rNo ❑ NA ❑ NE
No ❑ NA ❑ NE
No [I NA [I NE
El No ❑NA El NE
oNo El NA El 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):
V T� .519y6106A,sl Fl��� NEXT 7,V ,?>" le"n 1,Q1
f; f �o, Sa yI�FA /" <tv NO � �N GfT l.��i to, 4OZ12
A� �'f o
460ar`
Reviewer/Inspector Name I 1 Phone: D732
Reviewer/Inspector Signature: Date:
Paao 7 of 3
7 2/2R/l14 ranlinud'd

r
Facility Number: — Date of Inspection / D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. wYes ❑ No ❑ NA ❑ NE
❑ Waste Application Xweekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10
❑ No
PNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JVNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
;ZNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
El NA
[I NE
If yes, contact a regional Air Quality representative immediately
y
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
0 Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
ARM
D co
_7 vCp.
�aoq�p r��✓
WrCc�.�2A f ��
n
�)WO Al
CAwmp N
25) A)F E
C��4
`d�� .- SFr )1) ,Soup P94 7ro We"20,.
� CCU oC 5�Zkf
Page 3 of 3 12128104

Type of Visit d gRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 of: Arrival Time: �7 Dd Departure Time: County: OIJ,it_ *+J% Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: [ Title: Phone No:
Onsite Representative: AH u- ryrn-6 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: =' =' ❑" Longitude: = ° =' =
Design Current
Design C►urrent
Design Current
Swine C►►opacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
I I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
ER Feeder to Finish
'L3+60
do
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Layers
❑Non -La Non -Layers
El Pullets
❑ Beef Stocker
❑Beef Feeder
ElBeef Brood Cow
El Gilts
❑ Boars
El Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other'
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
El 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
dNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ET'No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 6-7 — e� Date of Inspection �L
_ rite 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: LAC001)
Spillway?:
Designed Freeboard (in): 9
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 2/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes V(No
❑ Yes LI No
El NA El NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental 7th eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7No
o ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window E�jl Evidence of Wind Drift [I Application Outside of Area
12. Crop type(s) C&j 3 . j4j J & V
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
[/No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
FrNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
WNo❑ 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):
rILA 01S5Z, LAGoopJ 1_60 LS To CorL.RX,�CT r61LAj IIND =4-Z'TXAL AFTut—
ReviewerlInspector Name TOW ICp AN CGI.� Phone: c; — �]
Reviewer/Inspector Signature: S Z Date: 9
Page 2 of 3 W 12128104 Continued

F/
Facility Number: — Date of Inspection 1�
$eauired 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 WNo
No El NA ❑ NE
❑ Yes ❑ 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
EdNo
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
G( A
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
Ll NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E❑fNA
[ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L2 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D 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
,/
2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
El/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

r
Type of Visit 10 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine 0 Complaint O Follow up O Referral . O Emergency O Other ❑ Denied Access
Date of Visit: � Arrival Time: /��OQ Departure Time: �� County:
Farm Name: Owner Email:
Owner Name: �%�.. Phone: _
Mailing Address:
Physical Address:
Facility Contact: 'Title:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =' =' ❑ Longitude: = 0 =' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
.
❑Non -La ec
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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Fleifei
❑
D Cow
❑
Non-Dai
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes P(No ❑ NA ❑ NE
12128104 Continued

Date of Inspection Z d
Facility Number: &q — im
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
VYes
❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1/
Structure 5 Structure 6
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 El NE
X
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
jZfNo ❑ 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 D,W(Q
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No ❑ NA ILJ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the wane structures require
(] Yes
❑ No ❑ NA [/NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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
A NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
�ZNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
Yes
❑ No
❑ NA
/V� 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?
El Yes
El No
El NA
�NE
z�rlle 10
zIn 4KA1/ -40 ry 1- ri EC E ✓J Li4' fiam Alw 4,2 JZL40
PR,6S�.JT�4-7F
Reviewer/Inspector Name .' ' ' Q.,.,. s`�s "�`. Phone: %� '7(p—�fZiOi'1�
Reviewer/Inspector Signature: Date: 1p t
12128104 Continued

3
Facility Number: — Date of Inspection !Z
Required Records & Documents ,�(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El No ❑ NA J�J NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA it NE
the appropirate box. ❑ WUp D Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below,
❑ Yes
❑ No
❑ NA XNE
❑ 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
❑ No
❑ NA 0 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA VNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA VNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA IfNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes tA No
❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA �NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes /No
❑ NA
❑'NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 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 XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes / No
El NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes ❑ No
❑ NA
❑ NE
Additional Comments`and/or Drawings - - - 7
11%ND4} C?7D �- �Zl �, wUw /Z' / _
_V
\�✓iJ
Q� � �FO � ��1�'i � L� 1/,� �i� � /'n
AA,
/17Ot��NG-,. Oha!✓ BA �® �,. �rRzr
'&XR-r
- IC ffkti i✓E �rc ,�+g zz-L
�1ttyODni �OvY� I�r��L Zp1V2c22kVa_
cUw �
` C K L od Ji`7aLy Fm SAD&-F�n S G wzr bAc+t.� �.
TairtPCZzr/jCT,

rf
S. s
Type of Visit 0 zRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: S aS Arrival Tinle: 1 27 0 U 7 Departure Time: County: OPUS1-o
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
OnsiteRepresentative: 1MdqdL5HA1_(— 7aY-6,L,
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Sack -up Operator: Back-up Certification Number:
Location of Farm:
Swine
Region:
Latitude: ❑ o = 1 = Longitude: = o = 6 =
Ld
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
b
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Daia Calf
❑
Daia Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2fNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection n3 v 5
Waste Collection & Treatment
4. Is storage capacity (structural plus storni 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: A4C'oij
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d�yp
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 CiNo ❑ NA ❑ NE
❑ Yes q4 ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes Ld No NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No ❑ NA El 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. El Yes 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) CL35 Cd`-y"U0
13,
Soil type(s) GG A RA 64 6
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
o ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
o ❑ NA
El NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[' ❑ NA
❑ NE
18,
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
n1 co 7O 40 GAr- a0 rJ taT-lC.e (-TicR
!sue rtu v P V #N- C0`4' ` - f C' L o Td Zj'r`.fs L C %J 6IL T) 1 "L0 tri ev
der $T°c:.1c �►.�(„ FRR.bv�r �r17'�+� r �QZ-.
Reviewer/Inspector Name ` ` TR"' L Phone:
Reviewer/Inspector Signature: Date: 3/ S Oo S
12128104 Continued

Facility Number. Date of Inspection 1 3 03
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes [ /No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
❑ NE
❑ Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ SoillAA alysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall tocking Crop Yield 0/120 Minute Inspections L'l Monthly and I"
L� SLI
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
dNo ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No I%NA
[:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No CNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[YNo `❑ 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
LJ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 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
UN o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[io
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[� o
❑ NA
❑ NE
Additional Cornments:andlor Drawings
12128104
12128104

Type of Visit .0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit X� Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: / Time: pOD
0 Not Operational O Below Threshold
Permitted 0 Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: .....t4!.!5R ............(....h.'&............................................................. County:......!.!! , fN......... »........... ........ ...............
OwnerName: .......1112D................!14�/................................................. Phone No:.......................................................................................
Marling Address:
FacilityContact: ................. ................/..�Title:.._.......... .... .......... ...... ......... .......... ........_ Phone No: ............ ........................... •.........
Onsite Representative:..,�f ��,�/Q, ....1...(l i15 ............................. Integrator: l../� �ti!`.................................................
Certified Operator:
Location of Farm:
............................................................ Operator Certification Number:
(Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 69 Longitude • 4 64
"� -.:e. 1 [ .3.1.];.r �. Erty S ° -! t ! t .,� to - . i ft a..f i F' 3'r i y_ C 7 - •r.
r' #II}esign, !,'jiCtxrrent RftE,'r; �( (: ..i f. € E: Design Current i s:.! r<€- 1 rc'r 1 7 { t
it} �€ r r 3 I IDe51�i1 ' Currelit
a acr f.POr`ulation �1 'PoWtry tl :1 Ca ACI' 11�o",aulati�IlaE E{;�` ittle, , 1%<cir� 'E`.a.i'ati 7'PO iulation �
❑ Wean to Feeder ;, j] Layer '„ _FNon-Dairy
Dairy
Feeder to Finish DO'" ❑Non -Layer ,�
ls�r, s#rirE�>>'irYz3���W°Sf,L> �i��.Et:@>L�6�.r.�':�a3i�-r.�,��t�ff� " i �
❑Farrow t0 Wean€ �� €iltll i �41E 11t if�it{ � �rJ t
i} 'J! a1Flr r
❑ Farrow to Feeder {❑ Other,
ai ;„i,rr�i {It r}rsiyi Z'r t•
}if
t 1t¢r€�i3�is"@ICI � ids' € I+ � �r;r Yrsts-,�a
Farrow to Finish Q ti € s r€ f ;. i
❑ i gb. x' 3 ' 1� ° �aZ'Otal �e5l Ilr(.$
Gilts
r�}�
❑
❑Boars i r € ��.nvtr�i s a1 �3i�iE flTOLa��l:•tl�.
., .-,.... , ... r.
�t
F�Number of Lagoons
i khn�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ;2No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9No
❑ Yes X) No
❑ Yes ZNo
Structure 6
Identifier:
Freeboard (inches): 92
12112103
Continued

i
Facility Number: 6!. —� Date of Inspection / p
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes R!(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
IONo
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes jZNo
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
❑ Yes 9No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes XNo
11. Is there evidence of over application? If yes, check the appropriate box below.
Yes ❑ No
❑ Excessive Ponding PAN Hy aulic Overload Frozen Grou ❑ Co er and/or Zinc
!
12. Crop type �/� .2
$,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWAP) .
❑ Yes 9No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes P'No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes JKNo
16. Is there a lack of adequate waste application equipment?
❑ Yes f "No
/
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[') Yes R(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 j2nNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes P?'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.
�I
/��D�Gz�i9- Tr�N•
L&
���� 2• A
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Field Copy ❑ Final Notes
1_1�6 AXA ZZ 4(1�7;
-5 1A AVI�1"Ax�w Ax Z,(,
PIC
xv 6A�5e 4FOC7�
�� L%s✓ �N�/SAS_ � ��P>•F�e'f�/�Y2r�- �!"pU
Date:
laiuivs c,onnreuea

Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes XNO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes /dNo
23. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Waste Application ❑ Freeboard [].Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes PNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
X No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
/No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
/?'No
NPDES
Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes�No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35,
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crap Yield Form [:]Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
' visit. further
© No violations or deficiencies were noted during this vrsit. You will receive no correspondence about this visit. f __
,..�....., ...... _,n+, .,r,--e:..e .,.�. ......i....... .., -i�; ?3 .., 9 f.. 3 �. ( gg 'ati�ti'i 9r g¢'t p� a € s
ddiUonalt:Comments andlor. Drawxn S: Ctl1°ii,t s f ' '',3 0 �i� .a.i i "' P'' Ii3�84; E;v S it 1r4; .i,ij ��, ;I fi i �' E;'l; € �t i y <°&,';
3d'1 ? r� 3LrsufiH! w !saY� �9 s{r ,.s;w(: �ra,<, a.?� ?u�Lr"I�dllll.+: Pr�4,.�����.°1
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or
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t^©��0_54661197094 � �s
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12/12/03

Type of Visit RICompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification JeOther ❑ Denied Access
Date of Visit: �' Timc:
Facility Number
Not O erational 0 Below Threshold
Permitted 0 Certified O Conditionally Certified D Registered Date Last OperatedorAbove Threshold:
Farm Name: E2vZti County:
Owner Name:Phone No:
Mailing Address:
Facility Contact: L,� Title: , Phone No:
Onsite Representative: 2 I/j/� AO!C: j'�L Ll —LL Integrator: _/_� f_mww 0e-d /✓
Certified Operator: Operator Certification Number:
Location of Farm. -
Swine ❑ Poultry ❑ Cattle
❑ Horse Latitude
0' �4 ��� Longitude
�' �6 66
Design
Current
Design ''Current
Design Current
Swine Capacity Population Poultry Ca aci " 'Po ulation Cattle Capacity Po ulation
❑ Wean to Feeder ❑ Layer I I JQ Dairy
Feeder to Finish k qW❑ Non -La et I JE1 Nan-Dai
d— I
El Farrow to Wean
❑ Farrow to Feeder 't.�. ❑ Other I_
❑
Total Design Capacit Farrow to Finish i
a ❑ Cults
❑ Boars Total SSLW
` �❑ Subsurface Drains Present �❑ Lagoon Area
Number of:Lagoons ❑ Spray Field Area
Efoldtng+Ponds 1.Sohd Traps 0 ❑ No Liquid Waste Management Sys
tem
., ' «drv�'«artiz '.� _„+a_a. ,,,, F?• L:.
Discharges Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c, if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2, Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste t' n& Trgatalgnj
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes j] No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches): 2
05103101 Continued

Facility Number: &05 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
El No
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
XYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Anmlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN 0 Hydr ulic Overload
El
El No
12. Crop type
13. Do the receiving crops differ with those lesignated in the Certified"Animal Waste nagement 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
Required Records &Docµmgllts
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
f 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
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
eeNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
.VNo
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?
P,Yes
❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
C�Urn entti (r.ye,fer to.question #) Explain ahk)XeES answers"and/or` a ny,recommendationstor any other comments,'
�Use'drawings of fecilityto better, eXplain situations..(usca'iiilitlonal:pages'as necessary)
R;_p - ❑ Field Copy ❑ Final Notes
���CYz��J �n?F_ !�✓�agle]l�OsS CZ 16S�F_�
kw v A10Q R a�r�s Fxz
��eD�yos .S,�wT
Reviewer/Inspector Name M
Reviewer/Inspector Signature: Date:
IL
O9103101 Continued

Facility Dumber: — Date of Inspection
dor IssuC1
26. Does the discharge pipe from the confinement building to the storage pond or la+goon fail to discharge at/or below ❑Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation. asphalt. ❑ Yes ❑ No
roads, buiiding structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
10. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missine or
or broken fan blade(s). inoperable shutters. etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submersed fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
7.lCrf�S
Of}r0'05
'4vty firm"'Jo
C 0 A ea"a Oc- 46, 111K
k 410 lv�t-
s �P,�s
AWe
nsin3io�

G
Type of Visit oCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 16 Routine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Z / O Time: 3 5 i 5
10 Not Operational 0 Below Threshold
Permitted [3 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: �'^y ;'^ -rle County: 0 J IV w
Owner Name: y r O +'ti Gn v "'� Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: ?lti A` S
Certified Operator:
Location of Farm:
Phone No:
Integrator: V r ' %3rnrnJ
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 ° K Longitude 0• 6
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca aci Po ulation
❑ Wean to Feeder 10 Layer I Dairy
❑ Feeder to Finish i ❑ Non -Layer
� ❑Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
1
❑Gilts Total SSLW
❑ Boars '
�3 Number of Lagoons �' ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
HoldingzPonds [Solid Traps [] No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )ErNo
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 PINo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? XYes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: I
Freeboard (inches): 1 1- 5
05103101
Continued

~Facility Number: �r] — 6S Date of Inspection Z r o3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 12rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ}
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? -2'''es ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? [:]Yes ,�TNo
Waste Application
10. Are there any buffers that need maintenance/improvement? 12rYes ❑ No
1 I . Is there evidence of over application? El Excessive Ponding ❑PAN Hydraulic Overload XYes ❑ No
12. Crop type 13--r%&,✓OCA �Cyt Sell' G✓ �^t, �or&I t'jk-2-,4, SO4S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �TNo
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
J'No
M.
Is there a lack of adequate waste application equipment?
❑ Yes
[20'No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
O'No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ZNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
,!fNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
42�No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ZrNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Q No
(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
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to"question #) ,Ezplain any YES answers and/or nny recommendstions"o any°ntler"comments
'v,. ,. .� ..
Use drawings of facility f6'betteKexplain situ ati6i (use additional pages as necessary}
„�❑ Field Copy ❑ Final Notes
7
3 b i TLr¢�e iS SoVte w0e.S4e F
orkded in Sow^ep area ioF 4lie' bg.nw..vs�a
�`;eid and wa3�e ;s P�ddleat ,...zed;Q��I aol' cen4 4,o 4L,e
bank hek-{ Td -�[i� �¢.- ✓�°t �';�i� . �iLe re�oeefeh+a4;ve_ s�ict
ina.d JOL'^ joed �eS+ce-dc.�j -1 -In ey 4o ��.�'�.�0.�'n (.R.9cion levC .
ek�la��ao� .44 i�I�er}'ah.c-e OF n+a-� ka ,rn J A tit'tit'sck-q.-De .
1 .
Reviewer/Inspector Name S4 o _r_WA 0 q+4'- S
Reviewer/Inspector Signature: 12 Date: Z 2 1 63
051031VI Continued

Facility Number: 6? —65 Date of Inspection 21 D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. 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 )2rNo
[:]Yes _`No
❑ Yes .I No
❑ Yes .ETNo
❑ Yes 40'-'No
❑ Yes ❑ No
Additional Comments.and/or Drawings:
-rkere is ok vAge bv;uur ;v14ke dagoor-, . srvet)e Yfeed54o be
rer+lovea( t%,A ekff om
t eM t. A CC -or AztPLc.e w:4L% Q
Yo t'x Sko%(d d o fk;� I" -4�a V e''`1 )iect - 1"v 4,,,-e
4k, I %lc,&rt (eve I,avA q1 Se 51^o--IA dp 4k; s �'� Youf 6er,er,f
pr1o+- +1; more ras-}r; C,4)V e hCjU 104; 6^.5 lra��..� �� Soo .-N .
10) TtNe 6vFfe,-• he"kA 4o +�P bcs;dc 41-c- 6e,-W%,L/0(q Fre loi
nee-ols 4e> be rv+lero./ed . 'p/ease 6o,-OaG4 4ke So;l i WR4e-- :D,--r4
Ede ot 1' '► a,t,A 44c" otG� lTG�
� -�-o i-mjar-o,•e -}Cie �vF¢¢� a{•tai I-aree�ertf
eras i a" iv, -�l-,e G r ,'^� i c g l A ✓'ea &
e -b s -F-�ie jeve I rr 40 be :N h; sa c,r i c�►i GerLGFr►1
a 4 41-1 :14 ; s 4-00 w e+ I h q k e 4 e (e'(S -�� p u'y +1'e- re
otr,e -}hvno(e/'Av,,,,v� Called. •Fr or+tiD r roW)otnd ;� see►�.r 44e jevel
o
^ � CAJ; y C4''+'t � ��1-} O1 t V )'o I ct,4 t' o -. 4k;j— w ee k-r"d . .T �'ta✓�
4';' e Mf'-aset�rTa'�'MVe. �o� �o t�vr+�� vni;I -geld Go dq,""S
q r e r: G,14—a-'T� - 40 O V -0 J 4 D vc r } o d lob `br a nA 4o #r-.i J'%'
-4f---4,e 4o Ye 10 o r-t 41ne ✓l0 t1 Ga'^ L� il, qr� 1` of qon •. jeve) . S �4 ?�
Several 411; S t7"_
Pq" keryo 6el�e t„�o,5, ,! 1
I (NL � ✓l q � � rye +'j-�j �
15 USe vere✓- wtA^q 5e"en4 o.F 4ke c+V0.i1Glb(d reSoLAfreJ +a
s�,rm,I 'V% Gor-. 1, AMt e � Add Am g 3rd �ov11 6�k ; ,%4 v r^ eid
-- j I-F SWrvi S Z' bJ 0 44-( d- A 614 64 Je0. s-t A e 0 u,o (e 0,Prit v re
61"e S j h' /e +kL; S M OL d e d ; J' 4 ,0 Plot-1
la✓1 L'J e4) Q D 1 e at c e es -ro -
4iAe �J1! +-r D�e-�a�►'t�t;►'�P� . 3Q A He✓-rta.}e 41,e eo.- ), wL%eC44, beot✓1
r04,A4ion 6e+-,agac.-,, 4Lie rota Gror F;elot s . Th,'s w;f( Create
q w11e �O L1 save q �aOt� ro4ot� tan . Lr1as-�e wtanQJcrrt }
Cam- �r,n� �L,Il S owa�,d -ihe rep}}rd bv� w;4k a lird-P41t-rw c;"cle
Pol- —k r rTAe "W pO'-{-e 4hi i Al Apt
gV\ekhcr 11aIFf6 314 tr"a e-r A gcre oF't.vr.-JPi6le afPOt rO''
O5103101

10aJE 4
Facility Number_ �O�I - Date of Inspection
Odor
oes the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liqu, ] of lagoon or storage pond with no agitation?
27. Are there any dea dis osed of properly within 24 hours?
28. Is there any evidence of wind drift during lan ation? (i.e, residue on neighborin Rion, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near i s of the lagoon?
30. Were any major maintenance problems wit entilation fans) noted? (i.e. broken Its, missing or
or broken fan blade(s), inoperable rs, etc.)
31. Do the animals a ins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments and/or Dirawiings:
a. n. e4,e ✓ v 1 l add dl �� a -� 1. d a v� Fd r- V ] �]
•
The Ol�{a�+ ;�na� pUI[ S1�r.��Gi! 90 �ke
)Ov 11 7 a►n d. 10 � c k VIP s o r1c a c{e (x5 e ) n +k e
CrvP {' r6liol I erhnypJ Z -10 3 Cay, be adde4
1kG rG -so ch
140,ve, 4Pke LA/a -RAe /P u l 1 �6e,0�y,�0.
�s� 6�eeoO�,.e.P1 4te otr�v/ a1�)C1-6,t4�4
,;-ot ; vt --k,a-� a� r�
i,wu Iekc_ ® rTl-%a rzPr-ed6Yl4,,tqiv2t
l6e4 t,,e¢ Y1 4k.2
on 4ke row G+^O�o -r-- e I/tr , E,\-sv re 4,esc so e+ O-C sr 14vcti, 0110
No ne-b •o c c v r b eCk c4: ve ICJ �©wlnLtlYtr Ga�i'�� �►-��t A�ti1CfS W L!O
2¢d 4
p L e: q yb d le n k e O V,5,,T 11 L✓a s +G nila wt ►'H e n rya u n a
V
e-A S I -le 4,,d n P. p f'O e e l Q n e u •^q n +,t. 4P
cen4 4o -etc -,tvA
(a7„ sa �, �
�'; � I d -}0 9a., � ►zto re otc �¢a, e
C4 has b e4c-i fi 11nwLc d 4k4 4 ity, w Kea-} e yob
,naw Gra� r eId tryQ- 1na✓V2s}�� r �nwevc,� � f]O ibt ll��
Sq 1bs nIi A✓Ld 1 1b3 AJ ee" A.611e �r�
'orie
3) ]� reS��G-}�✓�ei . -ni e� 4h.es w�Qa ak1A Q* o4ke�
-ww recel V6s tva-&+e,
a✓� �1arRnPO� C& r Cc*�✓L 44;x S,p�'�r<a} sn 4ke LJkera�- wail-]'1ec,s+
;fO e �La�eri{ `rt�
heedR . , f 1orac ce Skn,,.-1d he tvv;o(ed i&x 41,e
lvku.re is Jr, oreri� ;^zl Acat ;n gl1e w0.s4e f lict, ^-nA41\e
W,L5+e, p 1 a n -1k e vn 66'Wed -re t 4%t; r p r'ctC4-r ce ,
05103101

r
P"9e' S
Facility Humber: (o? -(OS Date of Inspection Z I
Odor Issues
26. Does the discharge pipe the confinement building to the storage and or lagoon fail to discharge at/or below
liquid level of lagoon or stora and with no agitation?
27. Are there any dead animals not di sed of properly withi 4 hours?
2$, Is there any evidence of win>public
applic ton? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, an)29. Is the land application sprayto ted near the liquid surface of the lagoon?
30, Were any major maintenance venti n 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 r.
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments an'dlor Dirawings:
5 �%1e L�Al e of rt no (.v .S kv wt 5 ip i �t iP� (� T % OK I+�/ r n�10Z►/
-¢cr 41'e l eo i 6 • '.�" - Q ", Ae sma/ I q r a �'�, ✓�rSepo� . Z`
40JA4tze r'fe
resen444 i >a i as+ J ea/` a •-td d a c u ..-•e ►'� �r-l� al �'1 d L
f10 til ; ✓\ c v "D ct ; — 4 L\-M.+ ✓10 n4,0 f'e a ,m►1 SO ] bs
i» 41nc S,ze-}. IS—4eknbef ck,.A tea v,,Lnre A
,-the- T7ebo^ L— ever, S5 16s oY
►Ni.ev'e hiks beevi ��O)Q lreol ir+� 7 an 45mil., 10„rI� 6
o► e pi r S Q V S5 I-ti�ci-� i t S e +^1e D I-2VkA d► 7 i o vt Q] A C"4 e If
Qs r�ded 4o 4 �e p l�h_ ots A,'rc Ussepl ✓
01% ✓Li-� r*o Ser. A'uR,.y 6e• a-GvA Gd C--,. 4Le q f i D w
50 165 i rr.s4e" o-r 160 0-kl -��r 5► 1 I
r^i- ov e-s eA 6" atie o' 6e44 yvflr 41,;s Pield -
"rLt;r L.,.,owid veel' ve4ke reS4,,JC4►0tiS o-br oLff ,'nod v,tv[e.1 rN
5P r ; -} ,� �d ems, n ►zd w1,a. y 6e. of 6e �,• s �-�I u q-� ; a �-, , b,,4 ho4
vz�Ge.ssgrst7 L-Q�}er,
'Pie-ase GQ.Lrvj� w�-1k yotr Sp�l bt„�r4¢' Vaisifi c# ),t-t-+dci, 0-
.�e.Gh•1;eal S�GGig1�'s� For o►ss�s-orrice 1,,,�-4t1-litesr ;4e,,r,s. Do rta-}
CaV Se POSAA. r'V it DPIC pe-f ri
1 v�JP G 4} i a'ti. J pt%.f'GLLa , C3Q 4o Sv rf"rtGt?
w4- G-S'/ O/' a-ly Pw-t eoryll'at-%C'e {..�41�►�-t�" y1�"'�, �J/� v"�a"'`4gP �Zle
�Q Joo4
05103101

�� o v t �' Q DiviSOII of Soil:and Water COtfSerY8t0>> t t' r r E 9. €EaL
C%`Other l;�,C�Cy
a.
...a ia:I
'type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f'Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
facility Number Date of visit: DZ Time: 12 00
16 Not Operational QBelow Threshold
Permitted © Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: C'^ ' n FOt County: d't -V °W
Owner Name: ? !a ,r'_ e ^ �f � � '' Phone No:
Mailing Address:
Facility Contact: /Title: Phone No:
Onsite Representative: Mn.-Sh I 1 Integrator: Aly�eA y
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 01 u Longitude •
Design,...
Current Dest n 'Current.-, ' " ° ' Destppn tCurrent
S�rrne; Ca acttV
ulatton E • €;.f"„iGa acitvfa o"igulshan' Cattle`,.,.,''i',1€'
P Ca "acity -: P, ulation
❑ Wean to Feeder
..Po §.'`Poutt „ .
ID Layer ❑ Dai'
El Feeder to Finish
` ❑Non -Layer '` ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder%]
Other lE a € '��:Ei € I,
❑ Farrow to Finish
,. ,€
Total Design Capacity
G�ltS
j ,
� 1 � at
€
•:i '
„
t '❑
Boars
.. E t 3f
1,E _
c _ l f3 1 i � ! 'C
f. f TotalfSSLW,
Nam_ ber of.Lagoons
�# ❑ Subsurface Drains Present ❑ La oon Area ❑ 8 rav Field Area I'
Hoidtng�Ponds'lSofid-Traps
❑ No Liquid Waste Management System
.,�,.;101
,,;
Disebarees & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JZ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes �No
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !
Freeboard (inches): 2 `!
05103101 Continued

Facility Number: (0 7 —& j Date of Inspection 13 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes allo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ YesZN0
(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 _2No
8, Does any part of the waste management system other than waste structures require maintenance/improvement? .lYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste_AWlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ffNo
11. Is there evidence of over application?- ❑ Excessive Ponding PAN ❑ Hydraulic Overload ,E fYes ❑ No
12. Crop type Ga-n,Whce,4 ,So`jbee?K.f e 13[,-m v den, —H.., f , 11 &-,v;—► lTejy
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes Z No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ZrNo
b) Does the facility need a wettable acre determination?
❑ Yes AEI'No
c) This facility is pended for a wettable acre determination?
❑ Yes )21'No
15,
Does the receiving crop need improvement?
❑ Yes , TNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes ,'No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes J2rNo
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 )2TNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Oyes ❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ZNo
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?
❑ Yes ❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ONo
24.
Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AV+'MP?
❑ Yes ❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
" r,.. - ... t - ... _ ,,. -.`',+ t ! - § •k4d-# i
Comments ,(re ier, to question#) ==Explain any Y1E�S answers,and/or an} recommendations or any other comments; i '' °
s of<faciii to better ex lean sttaatioas.Use iirawtng tY p , (tise_addttional pages as necessa !?) t �� , r❑ Field Conv ❑ Final Notes x
_:xr'.P € . n.ar„ f .ttn.. aL
I1 �lea'l % all�ll;le All�rvJgeh Wr�S ��I /i�Lf q¢ at ."Gtfe off` 11 s�acue?
-260-Z hea�- e���,
AVIX C,-ojO q Allowed 109 lbs/O-Cre pAAJ. #lso.)
j,viridaw O-F A6 mere ��1ah Sb lis ;n S1 4eAlbef An4
fl�h�,Gal�;on
Ocl,oCY ett-1 1 ?o PCle 4A,pr i SQ ,,q F~e b�- ✓Oe` 'm n,,>( Met-'eLk we._� rLC4
46., 4je 2-00 1-Zov2 eye e^op aln 3 PV11
.Followed
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: S P 3 ® Z,
05103101 Continued

Facility Number: rp S Date of inspection
n
dor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior 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.)
3 l . 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?
Addition aliCominents,and/or-,Drawings
rt.(fe,vt4;,-t -,4))
r 1 e 13rd!
lq.
95 4.r
ot, F-),61ot 3 Atoll
A J i,VagS Aff I, d 4r> 4Gte
,h
F�Ebf ✓cr r ) 200It, .
Yes ❑ No
❑ Yes JZNo
❑ Yes -2 No
❑ Yes ZNo
❑ Yes 2`No
❑ Yes ❑ No
❑ Yes ❑ No
Ttle,^e is na was-fe 6V',4(ys;l a� 4L 7ia►��aY� 20DZ
���r:��,�-�rdt.,�ve•��s. /71se� I->'he✓'e y-�r onlr a�,� coil-�a►ti+�%e
A n a f'7 s s /^o� 2Do Z-�t?eAe Y}C-'eofs 4P 6e
rxt"P 1 L <c ; Gt, lit e'qI, -�eq �' . �'Itase
7-he {i1rURSiC �� c,,n 41,e ��JZ-Z/i I ✓,
..1
LR. R 5tanao n."C'tk4 W'tl4e ;5- CO!1 .�.cy OGt� 1of' 00.e
Q� t) e '� D J<i e � S 1 a h 7 / ✓L�j 1 ✓\ t �^n 0 i { �JP f {/ a' v 7TG " C� PkA
t'�,v�v� l✓te� �V �G //�npw� Ei'i ieY,'�ni �lo"Se, PlBeLse f
J -t'a �c a64 ,Fvqf
fC� p ra-vy)4 4k,'S
r'i 1 JI
o) SeIAS Mc y 17e bu'l i�'l�✓ ur th 411 c
yvt�i� 1�,2E.'C� -�a �"jcr a�c��cSScp(-��tnot�oti�+ ct C=1CGt►tDGL-� p►^OGeSS_
42, . "P i en.s9 vto-t %'.r - tie �Zec� ok�t 1 4PF; ce C-P
+`'t 4 tw Cu 4 v e-e .
OSIO310I

S �I hA S1I�.. �1 j'I
Divistoii of Water Quality f
Drvislon of So
r
O F
7
iI and Water Conservation
Type of Visit R Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date, of Visit- oZ O Tiine: 0= Printed on: 7/21/2000
0 NNot Operational O Below Threshold
O�I?ermitted [:] Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
FarmName: ......... Ki! ....Lh................................................................. County: .cv.,.L.4...................................................
OwnerName: ................................................... ........................................................................ Phone No:.....
FacilityContact: ..............................Title:................................................................ Phone No:..........:........................................
Mailing Address: .........................................
Onsite Representative t "y►r f''e
.......... integrator
............................�...................
Certified Operator: ..... ............................................. ............................................................. Operator Certification Number:............ ...............................
Location of Farm:
f
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� �`� Longitude
Design Current .
Swine Canacity Ponulation
❑ Wean to Feeder
Feeder to Finish
g-goV
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 1EISubsufface Drains Present ❑ Lag+inn .Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste ,Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated. flaw in gal/trtin`'
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 t Structure 2 Structure 3 Structure 4
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes D(No
❑ Yes "'I No
Structure 5 Structure 6
Identifier: ............................................................
Freeboard (inches): ay
5100
Continued on back

FQcility Number: 1 —6S1 Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
)�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
b�k0
closure plan?
❑ Yes
(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
bfNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
t
elevation markings?
❑
No
Waste Al2Rlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic/ Overload
❑ Yes
ZNo
12. Crop type t C-('_C ! w e
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
allo
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?
MYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required Records _& Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
)j�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
eNo
21. Did the facility fail to have a actively certified operator in charge?
VYes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes P�rNo
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes JK(No
24. Does facility require a follow-up visit by same agency? es WNo Y
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes h2'No
yIQlatG€01s;o- 00fiewndes -wire gte�7 cl trig phis;visit; Yojl< will tecoiye Rio futt + ;
Torres orideirce: about. this visit: ... ... .
Comments (refer to question #): Explain any YES.answers and/or, any, recommendations- or, any: other, comments,y
Use..drawinks,of facility'to better.explain situations. (use additional pages as,necessary
{
�� �e� �o }2ve� c�� b�.� o�►-�t�� � �� -'tom � I.,��.�e�---�1�--��.� ' .
XVT
S� ` , c,ss .� • Sam c���e.s �e
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5/00

- cit Number: Date of Inspection , /� 3 �, Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
rtpves
❑ 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
KNo
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
�'N0
roads, building structure, and/or public property)
1
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
�No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
U'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
�S(Yes
❑ No
Additional ommen an or Drawings: E i
a-- - - A,
rL4
7 GLGL...e� ��� ��1iZe �z� C►--�f,� -�t��sk.5 ��,�+--`Ft��o�fi
A-
`1'�� ( � ��.}� �^c � �``� � ►—c�(c ems\ c �
AJAP we ,tee,

Division of Water Quality
Q Division of Soil and Water Conservation '
© Other Agency
Type of Visit xCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit X Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date, or Visit: r CJG Tine: I= Printed on: 7/21/2000
t� Not —operational Q Below Threshold
Permitted 13 Certified © Conditionally Certified [3 Registered Date Last OperE49�
td kbove 'Threshold:
Farm Name: ��.......................................... County: .........................................................
...............................................................................
OwnerName............................................................ Phone No:.......................................................................................
Facility Contact:..................................................... ........................ . Fitle: ................................................................ Phone No:...................................................
.
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative: ram .., ...,.......................... ............ Integrator: IN
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
A
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 14 Longitude • ° 46
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JCI Layer I I ❑ Dairy
Feeder to Finish G0 10 Non -Layer I 1 10 Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacit dc PC)
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds I 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, notify DWCI)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ycs, nolily 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.............................................................
Frechoard (inches):
5100
❑ Yes
N No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes W No
❑ Yes N'No
❑ Yes No
Structure 6
Continued on back

Facility Number: 69 — 06S Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement'?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of,over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application'?
b) Does the facility need a wettable acre determination'?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ 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'?
(ic/ 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?
: . iio•vio ticjns:or 4hc' jencies •rv'ere potted• 04ing • h* is:visit::You will •Teeeive 1io further • ;
• corresporidteh& abat f this '.visit.: ' • . '
[]Yes WNo
0 Yes ❑ No
❑ Yes 01'No
0-Yes J&N�
❑ Yes XNo
❑ Yes Nf No
❑ Yes ZNo
❑ Yes fMNo
❑ Yes Wo
❑ Yes ❑ No
❑ Yes ❑ No
C9Yes ❑ No
❑ Yes 9No
,XYes ❑ No
%Yes ❑ No
>EYes ❑ No
❑ Yes 9No
❑ Yes M No
❑ Yes N�No
❑ Yes brNo
❑ Yes XNo
❑ Yes 19f No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings offffacility
� to better explain situations. (use additional pa es as necessary): `j 1
T�)
ash J
Reviewer/InspectorNamc ti.�Q�3�s 3q{fQ�
Reviewer/Inspeetor Signature: Date: 5100

L J*
.. _... .,.. ��.,. x,.. .,.�.,..., ..,.. .- ..-:... ."r.. '�. :s:-•. ',',,..i, .. sr,_ '-:.,........+xAn.i..r..... ._,r ._ .. ..,r..Steee��,�f..s�lrm.Y.'.4:; ryV: i..- :�,.'�... �. «.....�r�"^. .. �.r..N.. -. J.- .,

Faeility Number: Cr)Dale of Inspection �U6 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor hplow Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
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 C�No
❑ Yes OPNo
❑ Yes O No
❑ Yes 6�No
❑ Yes XNo
Q �2>� � i�►'G�-.j C�'C- t7��S Qt"� CGI�']lG`Z !'T�
�V Vie--L-"
AL
1z I
i
�►� �. Lam- t.
N
l to Sit ` I 1904 L Lx 1,ci ci r7, C &L'-,s`1
rr.
N IN
ht
5100

Division of Soil and Water.Conse'r1.vabon Operation Revlew;.
..,[3 Division of Soll and -WateriConservation L.
Com lianee�Inspection, �' � "�j a +,.
:9Division, of WateC QklAhty .COeaplt&pC InSpeCiton `
0therAgency'�OperatioilRe eW. i�.l ,�... . ,',,tAi•, ,,��.... ��,� f. i.�,.#.(�� '-� .� f._.� -;
Q Routine 0 Com taint' Follow-up of DWQ inspection Q Follow-tLe of DSWC review Q Other
Facility Number 6 Date of Inspection
Time of Inspection ! 24 hr. (hh:mm)
0 Permitted ;0 Certified © Conditionally Certified 13 Registered 113 Not Operational I Date Last Operated:
Farm Name: 1 1 ..
.►11.!.C:.S.4Jr........�VYi��.............![h..................................County: ..... hl.?..................................... .....................
Owner Name :....... .:. j(Dl�..........Zilli/111.................................. Phone No:..��1 �O��Z`..... .�s j.............................................
............... ..........
FacilityContact: .............................................................................. Title: ......................................... I., .. Phone No:...................................................
Mailing Address: ...ms..... 1Cr!!v?Y1.�iutj!'�....�.......................................................... .....T�.`L�h1L1tt�S.t../1,1�................................... I..... ... �1�..4........
Onsite Representative:.......Q rfA!1.......rr �........................:................... .. .... [ntcl;rutor:......1`'� ..................:...............................
........
Certified Operator: ................................................... ............................................................. Operator Certification Number:....,.....................................
Location of Farm:
A
............................. ...... ..............................................................I... .................
Latitude =•` �" Longitude 0 ` 46
Design Current ,
Swine Ca acity Po ulation Poultry "
❑ Wean to Feeder
❑ Feeder to Finish
LA pp
2,405
❑ Farrow to Wean
❑ Farrow to Feeder.
❑ Farrow to Finish
❑ Gilts
❑ Boars
' Number -of lagoons.
Holding`Ponds'"/ Solid Traps
sign Current
►acity Ponulatio'n Cattle
'£ !❑ Non -Layer _. IJ❑ Non -Dairy
❑ Other
'e
' Tofal Design Capacity
Total SSL W
., ❑ Subsurface Drains Present ❑ Lagoon Area
'' ❑ No Liquid Waste Management System 71
Curre"nt
Pouulation .
I Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. li' discharge is observed, what is the estimated flow in gal/min?
d. Dices discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Yes ❑ No
Structure i S€ructure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �]
Freeboard(inches): ..................................,.................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3123/99 Continued on back

Facility Number: t��—�� Date of Inspection II
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did ReviewerlInspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
o yi6la[i6iis:or- 00•ritig this:visit: • Y'oit eeiye Rio 1Fu>�-tiier .
ctirres�ancience. a�put this visit.. . . . . . . . . . . . . . .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Coro ents'(refer ta'quesd-ionF#) ")Explatnrecorninendations oir,,any other comments 2Ot� 'i,;i'', t " e,-
USe dt aWingS,,of facility to3better'explaiw ituations (use addttiiinal'pages as3necessary)
) k)o3 .. oct o penx. Gi-1�Ai�_ AJ,,i<4 OLJwrs e,�4 f
11 1 1
iN�II�� UY WaS 1 1tLAT�*An `� �1�rt,UL +�vho' Mv,se 3 �6 disk tiP
W�`� �v5
yu ��7 YtN rt1v1c3
[�\
'S� 1 �
; "hf If1I
(UVOSS OCLC)• I
�e AL
�
S�rr.� � r so��cgt,—
�G��S ors
Sun. � �
c}�'� P.v�r�uI
YT} 7
Reviewer/Inspector Name �
J rL,Ez� _ t S .L .e ,.ar.± i :.d.'.L t...lt�s..? •-!�3��13•_¢a¢6r.6.# .t•:... ._.;e Enir.d d3 .,:.i_
Reviewer/Inspector Signature: Date: _qI q
3/23199

Facility Number Date of Inspection
Time of Inspection r S 24 hr. (hh:mm)
[] Permitted J9 Certified © Conditionally Certified 0 Registered JEJ Not Operational Date Last Operated:
Farm Name: ............ r'...... F.......L''J.-S.�r.................................................... County: !7 CTln%................,....................................
Owner Name �� h ..,........................................................... Phone No:...........,............................
r '
Facility Contact: .............................................................................. Title:............. Phone Nor.
......................................................................................................
,Mailing Address: ..................................................................................................................... ....................................................�r......�........................... ..........................
VhIntegrator: Rcpresentative:... p. .....GY.� .. Certified Operator: ................................................... ............................................................. Operator Certification Numbler:.............................
Location of Farm:
�................................................................................................. ... ................ ... ..................... ........
Latitude �'�� ��� Longitude �• �� ���
Design Current Design Current Design Current
�acy Polaon: ' `FSwine Capacity Pa ulation ':Poultry .
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Z r? ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder �a ❑Other
[3 Farrow to Finish ; ,:Total Design Capacity
❑ Gilts ;i
❑ Boars Total!SSLW
f e;
Number.oELagoons ..- , _.__�_��,' ❑ Subsurface Drains Present ❑ i.agoon Area ❑ Spray Field Area
Holding Ponds Sol Traps ❑ No Liquid Waste Man agemenE System
Discharl;es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (Il'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
Structurc I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ............................................................................................................................................. .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
Yes ❑ No
❑ Yes
1$ No
❑ Yes
No
3"ftaLJ ICtl<
❑ Yes
❑ No
19 Yes
❑ No
❑ Yes
❑ No
Yes ❑ No
Structure 6
❑ Yes 5 No
Continued on back
3/23/99

Facility Number: 6 (late of Inspection
6.. ArC there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? [:]Excessive Ponding ❑ PAN
12. Crop type
Mwim,
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes .❑ No
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 rcceiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Rio violafigris or cle#'icie�cies rp re nQt;ed d t`ft}g tis;visit: ;Y;oti} ;wiI-t cohi6 00%ttjicr ;
cOrrCS OnCiBIICe.AUt thlS .Visit. . . . . . . . . . . .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )§ No
ZYes ❑ No
❑ Yes ❑ No
-' �.'� "F -i . i t i .. i" }] � �
Comments refer to ;question #) Explam any. YES answers and/or any, recommendations or.,any,other comments E t PE I 7777, 1
.. t 3 it a� EE C I
Use drawings of facility to flatter explain situations (use additional pages as necessary.) : s� ! 1 i, •,€
�� J -�' I V c lq k 0P7 ire � � 4se ` o `
is ►F�owh ,f S Ur i✓! wlf4G 01�� -�lys� �rrn Dv1~r� yo�thd • �U� �� W�IS
-`°° hGgdad � ra4[l and 40w,:rfd dfa,noPc Iyeal. ,-r-Ner dv9 liale
4 CA4Cj, waste . s�capid -r'l use
hoilse 1 ifs e?1s Ad Are ck< UVf
r,)40(�t, ltoles�. %,��s7t�✓ +JA
✓iiiltnly1 -� �je�tG �'-�awgrc
F4 r n-> ee jit;^r<TQ • —
p `7 �
Reviewer/InspectorName !?2Lr1 }1 a' iti } /.��' �! ';�.•h Q r`'2Q t°'{
Reviewer/Inspector Signature: Date: jQ q�j
3123I99
(� rear e V iLi�"l Qr 4I� `"e n� l7egia u�Ik�E{e

Facility Number: — S Date of Inspection /p
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [:]Yes X No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes .� No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes IN No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or 1
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? (Yes ❑ No
,Additional omments an or rawin�r� o l' 's� l � I! �� 3 i,
C'? .u>. {, '�1 i-. k.i E,.� s ,r?a. , t,.3 .€;-{€ F 1.i` i 1.E:,'_(� t=, v ,� 3 i
).1 q6 d >4e� - �cse �
.Sq YV1e -�l
r� v ?I3' i M 4P b v e n L l, 44 foal ve d road,
fvdd f e of 69 1egd)'A aVa
pl l4Gl, 411e ff r4ar4S veyIC1,5e - O �r 1001d Inqr eg . �, o��►vler �)?IZ3ggf-
GLi t.u�, b 1 D ,
wggoy- vG l ,4 SG 12 ,' tvera tef kPl'7 ����
be i vt s ra eel _ fin i�r �rrick
��'16r �o lea v r nGt sic. .
o1e�►�cd U,p �r�s�� �rar� -F'I vs�, dank G�iSG'I��,r�e �fpr.�.r �iyt41
1L��yM1 gfeQ.
Advised 1'ew r-1ee- -6 me've rt r4-r)us� 4#7 k I OWA-d kO y GGhpVS&
Fa eewen`�' eVef r low tre'tn F"u fin I M &q+5;de- oF' fl cal 4a 4, on4o
f e di -ra , v"re -�� >re ve ~f c,�q S -�✓ dn'1 �a G�-� �a to i n
out of Scro d - o5k 4An kok7jo q roLu rd d 0e 4o
ff Gtor�s black/n�
S�.vo� . �U-} So r►�E� , �.� ` ,cD ereYen7 �e95 -rnom
bc5;de Shoo} And bv,td I 'Q�Is' de L0a11. ! l J
O ...14aac G1 �'e 40 be rer-,e ved .SU n A o n rva S� kI
a horses 0rl4,r lA oon '.s elf a s"1�e 1 ve-1 11 i�C�ef ® /eas4
h 9
Lower lagooh level ',t) a >res ��6I� w12n�er^
r
J
3/23/99

Cj:D.Nision of Soil and Water,Con'servation ,Operation Review
It �� %DLYI5FOn Of�Soil and Water'Conservation - Compliance -Inspection �� t �` I � s3 '�I�� Fli•E �,'
[RDivisign of Water Quality - Compliance Inspection rE
f "1 'D Other'Ag6 ey-'.Operation Review'
Routine Q Complaint Q l,ollow-up of I)WQ inspection 0 Follow-up of I)SWC: revicw 0 Other
Facility Number Date of Inspection
Time of Inspection FTUOO 24 hr. (hh:mm)
r
Mermitted O Certified Q Conditionally Certified 0 Registered 113 Not Operational Date Last Operated:
.• II
Farm Name: ...V {�'wr..� Countv:..... dLj........................................................
OwnerName:.....J ! `>...-vi........................................................................... Phone. No: .......................................................................................
FacilityContact: ...............................................................................ride:................................................................ Phone No:...................................................
MailingAddress: ..................................................................................................................... .....................................................................................
OnsiteRepresentative:�!;�d 11 1 ..,.�42�,iQe-�. Integrator:"��*'p:.4y.....................................................
CertifiedOperator:........................................... _.... ................. ............................................. Operator Certilication Number:.......,..................................
Loca 'on of 'arm:
srh................. t.... ............. ........... r..... ....G:.... ..... . .... ....... .............. ...... ........ .............. .... ....... I... .......... ..!!-- ... dSd° K.,. A
r.....,1...-,...........t-tl.. �,......................................................................................................................".............................,.....................
Latitude `14 Longitude 6 4C
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity. Population Cattle Capacity Population
_
❑ Wean to Feeder
_
❑ Layer-
❑Dairy
ceder to Finish
;)LgG0
'dGCd
❑Non -Layer
❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
JEI Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps JE3 No Liquid Waste Management System
DischaMes & Stream Impacts
1, Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes 'No
Discharge uriginatcd aL ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance titan -made?
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. It'discharge is observed. what is the estimated flow in gal/tnin?
d. Does discharge bypass a lagoon system?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0No
1 Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 4 No
Waste Collection & 'rreatinent
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):........................................................................
Il6l99 Continued on back

Facility Number: ! —C.S Datc of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed'? (ic/ 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 pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes "04VV No
XYes ❑ No
❑ Yes gNo
❑ Yes KNo
❑ Yes 2,No
❑ Yes DrNo
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes CgNo
12. Crop type ..... 1 !-.�..S6� .... �,. s
f .f. t.....j..........................................................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes RNo
14. Does the facility lack wettable acreage for land application? (footprint)
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 Pennit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel 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?
:: Xo.vioJations.or. deficiencies .were nonce durin*g .this.visii.' Y-6u' Wvi f rekceive nay Mriher. - .
eorrtzsbimidehee' about; this visit.: :: ....
❑ Yes D9 No
❑ Yes [2rNo
❑ Yes [9No
❑ Yes IgNo
D4 Yes ❑ No
gYes ❑ No
❑ Yes (XNo
❑ Yes [ No
'❑ Yes No
❑ Yes No
❑ Yes teNo
Comments (refer to question,#): Explain any YES answers and/or any,;recomrnendations,�or any other comments ! , c 'E
Use drawings of facility to,betier explain situations. (use additional pages as nece'ssary) ,i,'
,
aver �t-
�`�1 die r41� ►� CIA 5' -�- & �VN �_6R W� e,.� r tir ��XlrZ
�'CA'-)
Reviewer/lnspector Name
Reviewer/Inspector Signature: _ ��J� t��7� Date: J �� �`1 "� 11/6199

10 tcoutine 0 Lompiamt 0 rouow-up of uwy inspection 0 roiiow-up of ubw%_ review 0 viner j
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:min)
p Registered 0 Certified 0 Applied for Permit p Permitted in Not Operationa Date Last Operated:
Farm Name: Eindeisen.&.Erstarx.Fartu.......................................................................... County: Onslow WIRO
OwnerName: Byrom ..................................... Ervin ........................................................... Phone No: 32.4:.1.5.1.2....................................................................
Facility Contact: Randle.Findeisen...........................................Title: Manager............................................ Phone No: 32.4-.40.78 ................................
Mailing Address: 28A.Ery nlor.m.Rd.............................................................................. RichlandsL-DiC ....................................................... 28574 ..............
OnsiteRepresentative................................. .......................................................................... Integrator: Mar.pby-Famft.Earms......................................
Certified Operator: E apdy..West........................ Fl daisea......................................... Operator Certification Number: 162.40 ............................
Location of Farm:
Latitude ®•®° ©46 Longitude ©� ®` ®46
esign -u Ten
esign •ur en
esegn -urren
Swine
Capacity Poputipna
Plaltry
Capacity Popul a,tion Cattle
Capaty Po�puIation
❑ Wean to Feeder
❑Layer
❑ airy
® Feeder to
FinE—TF-❑
Non -Layer
❑ on- airy
p arrow to
can
❑ ter
To al' De ", n C pfiCiiy2,400
❑ arrow to Feeder
Farrow to Finish
❑
Total SSI,324,000
p Gilts
0 Boars
Numher°of Uagoons /Holding;PonXs ® u
surface ramsPresentp agoon rea ® pray ie Area
0 No
Liquid Waste Management SyffF6____j
General
1. Are there any buffers that need maintenance/improvement? 13 Yes p No
2. is any discharge observed from any part of the operation? 0 Yes ❑ No
Discharge originated at: ❑ Lagoon 0 Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? p Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) 0 Yes 0 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) 0 Yes p No
3. Is there evidence of past discharge from any part of the operation? ® Yes p No
4. Were there any adverse impacts to the waters of the State other than from a discharge? t3 Yes p No
5. Does any part of the waste management system (other than lagoons/holding ponds) require R Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? 0 Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ❑ No
7/25/97

Facility Number: 67_65 Date of Inspection
8. Are there lagoons or storage ponds on site which need to be properly closed?
® Yes
n No
Structures (Lagoons,Holdinp, Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
® Yes
p No
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier: .......#) (activel....... ..........................................................................................................
......................................................................
Freeboard (ft):
10. Is seepage observed from any of the structures?
rl Yes
N No
I t . Is erosion, or any other threats to the integrity of any of the structures observed?
® Yes
n No
12. Do any of the structures need maintenance/improvement?
® Yes
n 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?
n Yes
n No
Waste Application
14. Is there physical evidence of over application?
® Yes
n No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type...........................................................................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
R .�Nqyiqlations.or icrencies'were.nos anng this visit.,. on will.receive ncffurther.-.
,zo'rxe'spondene� �bou� zt iS:Yisi�;
n Yes p No
n Yes n No
n Yes n No
p Yes n No
N Yes n No
n Yes ® No
n Yes n No
n Yes n No
n Yes n No
n Yes n No
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
COMPLAINT/EMERGENCY REPORT FORM
WILMINGTON REGIONAL OFFICE
Received by: how-, (� o�� ,,cL -- Date/Time: 3l (319 r f 5 - u
Emergency. Complaint: County: oe .SIoJ
Report Received Ftx=.- '&:11 .. N6fr ,
Agency: Phone No.
Complainant; vie`
Address- Phone No_
Complaint or Incident:- Off--wg�j( hn.ec LAJ• tJ'o tikes_ -4L! C��zM-ior,g.
Time and Date Occurred:
Locatica of Area Affected:
Surface Waters Involved: GrousdwatezInvolved. Other:
Otber Agencies/Sections Notified:
1
EPA Region IV [phone] Pesticides 733-3556 Emergency Managnnent 733-3867 WZE-,$ Resources 733-7291
Solid and Ha wa our Wrote 733-1178 Marine Firheries 726-7021 Rater Supply Branch 733-2321 U.S. Caist Guard MSO 343-1881
127 Cardinal Drive Extension. Wilmington, N.C. 28405-3845 • Telephone [phone] • Fax 9ii-=50 =004
An Equal Opportunity Affirmative Action Employer

[] Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
IO Routine O Complaint O Fallow -up of DWQ inspection O Follow-up of DSWC review 'V Other'
Facility Number
Date of Inspection
'�
Time of Inspection Od 24 hr. (hh:mm)
Registered ;§ Certified 0 Applied for Permit 0 Permitted 113 Not O erational Date Last Operated:
County ........�!.0 : Farm Name: w >U
.r" .... ......1.N.......I�Y c�................................................... - • s %..........................................................
Owner Name :...... 4 rox%....... G f.VIN....... ........... I ....... .. ........ Phone No: 01.03X - 1512;......................I....................
Facility Conta et: ...... I...... ..................... Title:.....��f9.................................... Phone No: .8.l4,3.-.�4.:'.��
MailingAddress zn.....!�Y. TN+Oju............N................................................... ..... � fc+4lr� �a....r.ls......................................... ........
Onsite Representative: .......... A.ILk kai(.................. rv)nr.0.1........................................ Integrator:............ k............ "........................................
Certified Operator:............................................................................................................... Operator Certification Number;......}..
Location of Farm:
aar.t ....i.s...X r.......1. s ....� f .....01....... ......1�. `i..a...Ci.:S...t►t.LES.. cn...... R j... #. ...................................................................................
.......... ....... ,
Latitude •' " Longitude =• =` =11
Design 'Current
". Design 'Current q
Design::: .Current
2
Swme Capacity Population
Poultry
:
Capacity Population Cattle;
Capacrty::Population
❑Wean to Feeder
-> ❑Layer
k
❑ Day D'
P
Feeder to Finish
ots Zl{
❑Non -Layer
"
❑Non-Dairy
Farrow to We
3
3
❑ Farrow to Feeder
❑ Other
Q
Cl Farrow to Finish`
Total Design Capacityf
❑ Gilts
❑ Boars
Total"SSLW
(7�
.. ..
_.. _..
gin. -.
Numb ' f Lagoons I Holding $ands ❑
Subsurface Drains Present
❑Lagoon Area
Spray Field Area
q'.
s n
..
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
1A Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Continued on back

Facility Number: -1— S
8. Are there lagoons or storage ponds on site which need to be properly closed'? Yes ❑ No
Structures (I.agoons.11olding Ponds. Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate? M Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Stricture 5 Structure 6
Identifier: I {Ptk�
Freeboard(ft): ............. I ...... .........................................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ® Yes ❑ No
12.. Do any of the structures need maintenance/improvement'? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
i
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ❑ No
Waste _Application
14. Is there physical evidence of over application'? r Yes ❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type.................................................................................................................. '
16. Do the receiving cropsdiffer with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ❑ No
18. Does the receiving crop need improvement? ❑ Yes ❑ No
19. Is there a lack of available waste application equipment'?
❑ Yes
❑ No
M. Does facility require a follow-up visit by same agency?
0 Yes
❑ No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
r
22. Does record keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
❑ Yes
❑ No
24. Were any additional problems noted which cause: noncompliance of the Certified AW,MP?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0 No.violations or deficiencies.werenoted during this. visit. You4ill receive no further
correspondence ahout this visit.-
.
R'Viewer/Inspecttrr Name
Reviewer/Inspector signature: r �� 14 f Date: V A 3114�9�

® Routine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number
Farm Status. ® Registered ❑ Applied for Permit
❑ Certified ❑ Permitted
Date of Inspection
Time of Inspection ,�/ _ 3 O_j 24 hr. (hh:mm)
Total Time (in fraction of hours
(ex:I.25 for I hr 15 min)) Spent on Review
or Inspection (includes travel and nrocessinal
❑ Not Operational Date Last Operated : ...... ............................ ....... ................................................... ........ .....................................
FarmName:..... »0. V ! A.>........ AD.(a...... rA R.wt...................................... .................. County:...... f� vt s � b c�).............................., .........»...... `�
Land Owner Name:......t?.J. w.�L.......... zexA4,..,3........................................... Phone No:...»3. ...:.. �5 f Z�3.............. .................
......... .
Facility Conctact:..1t 19rx? ..... !.. t17�r ........... Title: ............... Phone No:....Z .�. n7 . ............... "n
Mailing Address:... $ .... .QVi✓140tV 1.............�o�.`�......................................Q!.CrN1rpN'?�.............................................Z.���.
Onsite Representative: .................. !.!.:_'.:............................. ........ .....................................................
46
Certified Operator: .... �V+ 1.1�.................... ...i. �..!�.S .�.................. Operator Certification Number:... �.V.. L...........
Location of Farm: I
Latitude EIE' " Longitude • '
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Q-No
2. Is any discharge observed from any part of the operation? ET�'es Rio
Discharge originated at: Magoon ❑ Spray field Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes RNO
b. if discharge is observed, did it reach Surface Water'! (If yes, notify DWQ) ❑ Yes [moo
c. If discharge is observed, what is the estimated flow in gal/min? AJrb�­
d. Does discharge bypass a lagoon system? (If yes, notify .DWQ) ❑ Yes M No
3. Is there evidence of past discharge from any part of the operation? QYes [j'Ro
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑.,`Yes GKO
5. Does any part of the waste management system (other than lagoons/holding ponds) require O'l es ❑ No
4/30/97 maintenance/improvement?
Continued an back
A

Facility Number:...it�.....—...l:C..
6. is facilitynot in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes O No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
S(LagoQji� anAlor Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
L.4........... ......�.............. ........�..........
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes (- No
0'1 ❑ No
❑ Yes ❑'ISO
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Wa5ic Auplicali2n
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....Lao?.V ............................1. ! ...k.-r. ........................5; ..G.......................................................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?.
Eor Certified Fauilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes B No
['Yes ,❑�No
[ff Yes t_✓J No
B Ycs ❑ No
❑ Yes L7No
❑ Yes B-II o
❑ Yes 9-Ko
❑ Yes G3-No
❑ Yes Bl
❑ Yes 9 o
❑ Yes to
es
FOU i E
24. Does record keeping need improvement? Y.Y�YW ❑ Yes LjNo
Comments (refer to question'#) Explainany YES answers and/or any, recommendations or any other comments
Use drawings of facility to better explain situations .(use additional,pages as necessary) > z, 2
�ev ;� ,I\ t5�
TE) S CAt, `L,-o A S�,4o zecP
A.s p u AJ Ge-5 5+- S.
WA,4✓ /5 D � �
cc: [rtvtston of water Vuauty, crater Lruattry, aecnon,.racittry Assessment unit 4/JU/Y /

Site Requires Immediate Attention: -
Facility No.._(p 7-
DIVISION OF ENVIRONMENTAL MANAGE?vIENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD -
DATE: 3 _ Z(. , 1996
Time:
Farm Name/Owner:.._-;E,. 9 U r AJ '�-N�� �44i&d 1 N R
Mailin Address: _ On ef40vyt T0'-L--'►-1 %C�
County:-
Intezrator: Phone:
On Site Representative:
Physical Address/Location:
Phone: Z -/ � Z.
Type of Operation: Swine Poultry Cattle
Design Capacity: ? Number of Animals on Site:
DEYI Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 � ' z1 Longitude: ' ` z Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25. year 24 hour storm event
(approximately 1 Foot + 7 inches) es or No Actual Freeboard: 2 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or(TO Was any erosion observed? or No
Is adequate land available for spray? or No Is the cover crop adequate? ?? or No
Crop(s) being utilized: _ (_eD�c� 5✓l. -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? rZ or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(7
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes olln)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orb If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes ora
Additional Comments: _( �iYn�J�� r�� ;�✓t5 pP�`U''� - �Op�i�w"'+
Inspector Name -nature
cc: Facility Assessment Unit
lase Auacliments if Needed.

y
Site Requires Immediate Attention:
Facility No. 7—�
DIVISION OF ENVIRONMENTAL MANAGEMENT
AND/AL FEEDLOT OPERATIONS SITE VISITATION RECORD .
DATE: Z 1996
Time: U ��
Farm Name/Owner: t _2_ f;41—t.c i
Mailing Address: sfi&Lvi Tow✓I - - (_AA) QS
County: d YlS 0Lc>_
Integrator. �..`c Q ��r�•����.,.�`�` — ----- Phone:
On Site Representative: Phone:
Physical Address/Location: r C 24 _
Type of Operation: Swine Poultry Cattle
Desi--n Capacity: 2 ? Number of Animals on Site:
DEM. Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
_,-',,.Circle Yes or No
Does.the Animal Waste Lagoon have sufficient freeboard of 1 Foot T 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)(:?S�or No ..Actual Freeboard: Z Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or(o Was any erosion observed? or No
Is adequate land available for spray? or No Is the cover crop 'adequate? b or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? for No
100 Feet from Wells? ?�A or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line S Cream? Yes or(o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Nlap Blue Line? Yes ott1g)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orSOD If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes ora
Additional Comments: �lin�, ►�'�ir Gjp�i�wv�-+
Inspector Name -nature
cc: Facility Assessment Unit Us,- Attachments if Needed.

•
I*
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:, 1995
Time: A;Q 0
Farm Name/Owner:
Mailing Address:
County: 0All
S E- e� l//N
,.r / (-;,e v,
Integrator: Phone:
On Site Representative: 1 Qom` incLei�s ems► _ Phone: 3n7 �4 ' /5 /,:;?-
Physical Address/Location: „/+)r zy �7usy- ov.sr ed 1S.e��
Type of Operation: Swine t/ Poultry Cattle
Design Capacity: _ _2.5-6 Number of Animals on Site:-
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 q 5 q ' aZ d. `Y(" Longitude: 7 7 3 `%Z " Elevation: 3a Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: j:� _ Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes orb
Is adequate land available for spray?'Ye"r- No Is the cover crop adequate? Yes or No
Crop(s) being.utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is'the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or e
Is animal waste land applied or.spray irrigated within 25 Feet of a USGS Map Blue Line? Yes of N
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or�§ If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, Iand applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
r
• buAM(57-
Inspector Name
-�z &'C'"Zzet
Signature
cc: Facility Assessment Unit Usc Attacliments if Needed.

OPERATI0NS BRANCH - WQ Fax:[phone] Jul 95 '95 7.27 P.06/17
•
Site Requires Immediate Attention -z'4_
,Faci-4ty Number:
SITE VISITATION RECORD
DATE: .Z I' 1995
Owner: &,to..r n r.�.. _ Farm Name: A :,r:..
County: a.a
Agent Visiting Site: N,,4e Phone: 4i#J _4Yrr-
Operator: _ 4 Kog,, .... r �-' - P11011c: 6frc / -74V-
On Site Representative: , � •- i .+c M c..+.-. Phu=
Physical Address: •� '. = •� t� EXr.rvf a.v rrl - vim'Mt �x..�: a•�.•�lot
Mailing Address:
Type or Uperation: bwtne 1 Poultry Cattle
Design Capacity: _M!r,7 Number of Animals on Site: ^ 40!g= -0. -
Latitude: _ o r' -Longitude: 4
Type of Inspection: Ground L�- . Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot +8 inches) or No Actual Freeboard: .7 Feet _ Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes oriio-)Vas there erosion of the dam?: Yes or4s5)
Is adequate land available for Iand application? Yes ot(`2ps the cover crop adequate? Yes or(o
Additional Comments: _ A,,a % .- v.+•.*�..aTrr.� __ _ __ __
Fax to [phone]
Signature,of Arent
I