670080_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: U7Routine
pliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: ONJIfftl Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 1e0,n'e '&z=W3dj
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 16
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop. Cattle
Layer Dairy Cow
Design Current
Capacity Pop.
;
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Dairy Heifer
Design Current Dry Cow
Farrow to Feeder
Farrow to Finish
Dr, P■oultr, C•_a acit Po Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 1�40 [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
❑ YesZo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - jDate of Inspection: J
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes OZ"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: Lj4&<ywj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_ 17
5. Are there any immediate threats to the integrity of any of the structures observed? Yes E., No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ONo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments threat, notify DWR
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 � ❑ 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 [3NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0Yes�VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes I_J No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes � o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes WNo
❑ 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 YNo ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes j No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

lFacility Number: - Date of Inspection:
�4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E3 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E�/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
/xo
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesFN
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yeso
❑ NA
❑ NE
Comments.(refer to,question;#): Ezplam:any YES answers; and/or any additional recommendations; or, any: other comments.
Use drawings of facility to, better ex lain; situations`.(use additional: ages as. necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
21412015
�� T a ' �911))�f4
l V

Type of Visit: 0 Co pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: O/VSL.A�✓ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Sz oc r � P(� S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: t6&3
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
iLayer
Design Current
Wet Poultry Capacity Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I INon-LaXer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dt. P.oultr. Ca acity, $o .
Layers
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes /No ❑ NA ❑ NE
[-]Yes ❑ No
[:]Yes [—]No
❑ Yes [] o
❑ Yes o
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facili Number: I- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
llStructure
,I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes Noy' ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZV/07N(o
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
6N9,
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o ❑ 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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
I!0< I
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo ❑ 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? ❑ YesVNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facih,,1V Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . MYVNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C21 <No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes ZN ❑ NA ❑ NE
❑ Application Field [D Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [] Yes >o❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain;any YES answers and/or any additional recommendations or, any -other comments: :
-]
Use,drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
4
If
--i3 ff

Tyrit of Visit: d Co liance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint 0 Follow-up 0 Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: 5=County: Q64J(Apyl Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �� 2iLY (2�LDljS Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C►urrent
Design
Current
Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity
No
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr.
@a aci
PQo P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poutts
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes,, notify DWQ)
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 ❑ ❑ NA ❑ NE
❑ Yes ❑ NA [] NE
❑ Yes rNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: tE'
Waste Collection & Treatment
4. Is stodge capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 o _
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 �io [DNA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ;ZrLd NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes; check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
9�yo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ 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 WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [?No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ltJ " ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: C117 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C ] NA ❑ NE
25. Is thevfacility out of compliance with permit conditions related to sludge? If yes, check ❑ YesVNo ❑ NA ❑ NE
.the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes WNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 ff No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes [❑ NA ❑ NE
❑ Yes RJNo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes 50/E:]
❑ NA ❑ NE
❑ Yes NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone rb
Reviewer/Inspector Signature:
Page 3 of 3
Date:

(Type of Visit: d rRoutine
pliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: L2euaj Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Tit e:
Onsite Representative: --r6my �j n-'ab
Owner Email:
Phone:
Integrator:
Phone:
Certified Operator: Certification Number: 16A31
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Wean to Feeder
Non -La er
Feeder to Finish
��
Design Current
Dr, P.oultr, C*a .aci P,o P.
Layers
Non -Layers
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turke 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 dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
DNA ❑NE
Page 1 of 3 21412011 Continued

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

Facility Number: - 0 Date of Inspection:
+� 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes��No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑Yes
U No NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
2 No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
LJ No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
l_J No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CfNo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
d ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (referto question #): Explain any YES answers and/or any additional recommendations or any other comments.,,,
Use drawings of facility to better explain situations (use additional pages as.necessary).'
ri E to 3 N A5 P-T" Za LE v E LS , i4 aT 3v o b YET. j{E CO Mrv� ENS WC p
-T Z cJ. �O 2- Zt rt-C n. e\z:L>CT 1J KL _ ._. .jv-r US`C Ut.'% rUL �o tL �ER_TS LZ L'f-V
< P's A l(r4 rAL C.°�TCN$S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (911 ! 16 —In I
Date: 3Ull
21412011

Type of Visit: (jCorl6pliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Ems[ Arrival Time: $S' Departure Time: County: _(21j Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1L�_ RG?mi soC
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 1 r
Certification Number: 1j 1
Certification Number:
Longitude:
SwineEltlyieslgn Current Design Current
pacity Pop. Wet Poultry Capacity Pop.
a11
an to Finish Layer
Cattle
airy Cow
Design
C*apacity
Current
Pop.
an to Feeder
Non -La er
airy Calf
to Finish
6
Dai Heifer
ow to Wean
Design Current
D Cow
ow to Feeder
Dr, P,oultr, Ca aci Po
Non-Dai
!Feeder
ow to Finish
La ers
Beef Stocker
s
Non -La ers
Beef Feeder
rs
Pullets
Beef Brood Cow
eke
er
ke s
Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No 0 NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes L 1' ❑ NA ❑ NE
❑ Yes [10 ❑ NA ❑ NE
Page I of 3 21412011 Continued

Fact i Number: 62 - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �t0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�J"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 C2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 ❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
io ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'transfers ❑ Weather Code
❑ Rainfall [:]Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes <o ❑ 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

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ek4o ❑ 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 fait 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
❑ Yes
❑ Yes
❑ Yes
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
Na
❑ NA
❑ NE
/Nc
❑ NA
❑ NE
E Ngo
❑ NA
❑ NE
No
❑ NA
❑ NE
<No ❑ NA ❑ NE
❑ NA ❑ NE
o ❑ NA ❑ NE
(Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments ? I
Use drawings of facility to better explain situations (use additional pages as necessary). g r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M
Phone: / - JN
Date: �3 T
21412011

Facility dNumber:
Q
toit�of Water Quahty�,,'; 1, iI fi ,
]on of:3oil and tWater Canscr�v,:ittoi
z
J
Type of Visit 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: Arrival Time: Departure Time: County: 6Jlhs%.61✓ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: c = I Longitude: = 0 0 ` = "
a.'s,
-Jtk s k�s€ 'gym s� "�-.a xis* #y� k:.°gm'-,q..* y
Design Current, q' & `N; : ci £) Uestgn:r Current 3° c' �'i " x;{Destgp1 Current,"
Swine i i' Gapac�ty Population y Wet.Po.ultry Capacity} Population ";Cattle ' ?; , kCapaeity�{Aopulattvn'
3 F ° ❑ Layer q'
� ❑ Non -Layer
1
4; ��8's� �:.'9C gat ka aS
t } l.r gryPoaltry
t
Other, .
N.
❑ Other
, sYf
Dr
on
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
CEO
50'L
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turke Aoults
❑ Other
�
4' L•
❑
Dairy Cow
Dairy Calf
El
Dairy Heifer
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
Z. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�zo
❑ NA
❑ NE
other than from a discharge`?
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 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure) Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: um
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 276
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ 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 th eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 7No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) WNo
9. Does any part of the waste management system other than the waste structures require ElYes ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes L{No ❑ NA ❑ NE
maintenance/improvement? ��,, //
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E ,❑ NA [3 NE
❑ Excessive Ponding El Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.) //
❑ PAN ❑ PAN > t0% 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 [Z o ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? ElYes fJ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 0 o El NA El NE
17. Does the facility lack adequate acreage for land application? El Yes
Yes � ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes U No ❑ NA ❑ NE
Comments (refer.to°questtun #} ,Eiplairi any YES,ans►vcrs aridlor any recommendations or any other4comments ` r
Use drawings. of facility to 4etterexplain situations. (use`,addthon'al pages;as neeessary): i `t i ( �
Reviewer/Inspector Name Phone: ID L46 $
Reviewer/Inspector Signature „_ Date: G�-7 tt
Page 2 of 3 1 12128104 Continued

Facility Number: (� Q Date of Inspection
Renuired Records & Documents
i
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other ,�/
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [: No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" 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 d o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes Id No ❑ NA ❑ NE
❑ Yes �o El ❑ NE
ElYes No ❑ NA ❑ NE
❑ Yes U�No ❑ NA ❑ NE
❑ Yes L'1 N ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑Yes o ❑NA El NE
❑ Yes
❑ NA
❑ NE
❑ Yes
�No
Id No
❑ NA
❑ NE
❑ Yes
WK—INNINo
❑ NA
❑ NE
A`ddit'ional Comments anilloir Drawings `,_ a �; ; i ;:°1��`'�� afw�.
T
Page 3 of 3 12128104

G 11 N yo
Type of Visit (b t;o�npliance 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: Arrival Time: ® Departure Time: County: QNSL6k1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = I = Longitude: 0 ° = ` 0
il
Design Current Design Current
Capacity Popul� a Wet Poultry C►apBell y Population
"wean
Design Current
Cattle Capacity Population
Finish
❑La er
❑ Dai Cow
PFeeder110
Non -Layer
❑ Dairy Calf
❑ DairyHeifer
❑ D Cow
El Feeder to Finish
❑ Farrow to Wean
Dry Poultry,
❑ Layers
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Dairy
❑ Beef Stocker
❑ Non -La ers
❑ Gilts
El Beef Feeder
❑Pullets
❑ Boars
El Beef Brood Cow
Number of Structures: r
❑ Turkeys
El Turkey Poults
Other
❑ Other
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E 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
KN
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Ld No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 6
Date of Inspection �.t.
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into -the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA C.dor.)
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 ElNA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElYes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes & ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 �o [DNA ❑ NE
maintenance/improvement? _.�
11, Is there evidence of incorrect application'? If yes, check the appropriate box below. El2 Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
ETNNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
No
❑ NA
❑ NE
Comments (refer tw.question.#) Explain°any YES answers and/or any recommendations,or any oiher�comme'nts
Use drawings of facility to better explain situations'. (use additional pages,as necessary):
"A'
S�'0 10AS at/t�. A#VLrkD 19�a C� WC--r 1�.xNtC�. ++ors v00(-as ►YAt (� o.0
fAij PCr 14CR--- , Cd ILJLC C-`r an/ UP Cay^XXJ 04 AMa Sr, a iAn/ 6�_
5� Ts Tj
Reviewer/Ins ector Name € ' Z -`g' r: '4% t7
s- Phone p iD $
Reviewer/Inspector Signature: L. Date: u
Page 2 of 3 1 12128104 Continued

Facility Number: — Date of Inspection tJ(.
ReVjired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Doe record keeping need improvement? If yes, check the appropriate box below. 16Yes [:]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
[�Z�o
El NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C3 o
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
go
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[N
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
L Na
❑ 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
30.
and report the mortality rates that were higher than normal?
At the time the inspection did the facility an odor or air concern?
❑
of pose quality
Yes
[I NA
[I NE
If yes, contact a regional Air Quality representative immediately
7No
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
❑ 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
dN o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

+` Facility Number
Type of Visit 7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 6 Arrival Time: d u Departure Time: County: 0~1r(11 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e = & = Longitude: = o = & = 1{
Design Current Design Current
Swine Capac ty Popullati N'et Poultry Cap city Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
110
iry Cow
❑ Wean to Feeder
91 Feeder to Finish
Non -Layer I
I
i Calf
❑Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
Dry Poultry
❑ Layers
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
❑ Boars
Other
❑ Other
El Beef Stocker
Non -Layers
❑ Beef Feeder
❑ Pullets
ILI Beef Brood Cow
❑ Turke s
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EdNo
❑ 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
❑ o
ElNA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
[3Yes
EN
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

�>11
Facility Number: — qQ Date of Inspection
,t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ffNo
❑ NA ❑ NE
a. I ryes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structurre1I Structure 2 Structure 3 Structure 4
ff ��
Structure 5
Structure 6
Identifier: (A � /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2/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
[Z/No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
No
El 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
,_,/
l-1 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
ffNo
❑ 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
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
eNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
LJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�T
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
-.,` INN,
yComments refer to' ueshon #E _'Ex lain anyYES,answers and1or an recommendations or an other. comments
<ti: a ( .q: ) ep t'r �., , Y a Ras e w .,, � ayt
,Use drawings?of�lacility to lit t'tcr explain situattons'. (usc'n'tldihonal pages nece sary}:fit, g l� ..,�I
;9
11
AL
ReviewerlInspector Name
Phone: I ' ML
l•
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

�.
Facility Number: — Date of Inspection b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ 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 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 ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes Inspections
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes d o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 20 ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �2 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes L'J No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PKNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
��
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
L✓� N
El NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
,�,�No
O'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

acility Number I 6 7 H $o I�� Division of Soil and Water Conservation V_I
� Other Aeency
Type of Visit 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: ' 3D Arrival Time: ® Departure Time: County: dNjtr6 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: f� Title:
Onsite Representative:�>✓
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = t = Longitude: ❑ ° =
Design
Current
Design Current
Design Current
Swine
Cap�circty
Popplation
Wet Poultry Capacity Population
Cattle Capa�etRty Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Puliets
❑Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Pouits
Number of Structures:
❑ Other
1110
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C6"xo
❑ 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
❑ INN
❑ NA
[INE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
l N
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

i
Facility Number: 7 —
Date of Inspection b a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes n No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
trycture Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
/No
6. Are there structures on -site which are not properly addressed and/or managed
El Yes [0
❑ 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 thhr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes l(J N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes [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/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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) .
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
IX4
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
(o
[3NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El
��N
El
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes;Zo
❑ NA
❑ NE
�fi'rfiit ,� a�:°
Comments (refer to question:#} �t Explain(any'Yi1S answers and/or any recommendations or any other comments:
*"J '�'i; .-,..��.i S:l& .,
Uses drawings of facthty46:better explain sttuahons. (us addthonal pages as essary):
$ i�tf.".'Y €f:`: ,?< I.i i ,.:5_ i ;k.,r w# z'4"t"M rt alp
zs:) FWOCK, WA1D 119- ECt'-e TL< C49 Y TO ot-0 -F +sd'r Oa SL-V06 E
SOPLdeq KAIC p 30
Reviewer/Inspector Name- odQ�,./ �� Phone: (b 7rL
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

.1
Facility Number: $ — g6 Date of Inspection 3a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L" No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L"J 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 M /No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ' E No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes do ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Zye
s [INo ❑ NA ❑ NE
s ❑ No ❑ NA ❑ NE
❑ Yes ❑. o ❑ NA ❑ NE
❑ Yes ❑ No 2NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes , To' ❑ NA ❑ NE
❑ Yes :0��D
NA ❑ NE
ElYes NA ❑ NE
Page 3 of 3 12128104

Division of Wa er Quality
Fadliq Number Division of Soil: and Water Conservation
Q :Other Agency y
Type of Visit O TRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 1 U I Arrival Time: Departure Time: County: GYI AIY✓ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: D Title: Phone No:
Onsite Representative: �Ex+�'� I� 0^� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e = ` = " Longitude: = ° = ` "
Design Current-'#
Swine ;Capacity Population i
❑ Wean to Finish
3 Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gibs
❑ Boars `.
Other,
"Design',`: Current Design; Current
Wet Piipltry apacity,'-Population Cattle Capacity Population;
JU Non -Layer I I I
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
i
Number of Structures:Z3
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
d o
El NA
El NE
El Yes
7No
❑ NA
❑ NE
12128104 Continued

Facility Number: &T El Date of Inspection o'7 1
Waste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: (AcrgrnJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 111�
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IQ 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 L1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes l( No ❑ NA ❑ NE
maintenance/improvement? , ��
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElE3 Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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
E No
❑ NA
❑ NE
[No
❑ NA
❑ NE
No
❑ NA
❑ ' NE
�o
El NA
El NE
E No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES.answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):.
;l) C'gI-r.Ct MCV A &f vN WA -r r�,Lp � N6, tj�Cc _ A
Reviewer/Inspector Name I _. �, Phone: "
Reviewer/Inspector Signature: Date: 3 zhv-7
Page 2 of 3 112128104 Continued

FAcility Number: 6 3 — Date of Inspection t L o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L5 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Z"Yes ❑ No ❑ NA ❑ NE
[2<aste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ffNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
eN ❑ 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
L�lv ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3NZo
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
12'N0
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 l . Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E3<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerhnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ETNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E N
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 .12128104

E
f Visit Co7Oliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit G Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: 6 Fj Arrival Time: ,dV Departure Time: County: aA4rU1✓ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: TeXll r 13AZ1. LAJ Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: = o 1=1 ' =
Design C■urrent
Design Current
Design C►►urrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑anFnish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer
❑ Dairy Calf
❑ Feeder to Finish 11
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
El Layers
El Non-Layers
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El
VNV
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

I
Facility Number: Date of Inspection
�T
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes UlNo
❑ 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 ffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L' 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 3 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (�,J t J3 ,W) S cc) ,� / ' I
13. Soil type(s) TOr-��'a /4c �/Vj Al4rr llc Lyn ca-U.-I
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes [:1 No [I NA [I 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendationsor any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): .
u.) UPOAT - ',0 crLq -e.r6Lo FoWV\ At,b Of c4kVsST&,fr o>✓ 1"
MUM, VJAP6-C7&)A1.
oWd C& /3V_'Z,6 A/&, gt" M 1' o v4 t! /I/G&j hlvP jh/C-, o 4A &A" vJ
f1w1c 0 AT.
Sul'm�g s 0"C i APO NLAr
Reviewer/Inspector Name 1 f f��i �,t T
I Phone: t j
Reviewerllnspector Signature: 1ja&
Date: j 3a o(,
Page 2 of 3 1 12128104 Continued

Facility Number: '1 —g1�1 Date of Inspection I
Required Records & Documents J
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design El Mans El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Ld Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ So
ilnalysis El Waste Transfers El Annual Certification
El Rainfall El Stocking l �l Crop Yield ❑ 120 Minute Inspections and V Rain Inspections ❑ Weather Code
❑ Yes � o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [I Yes WNo ❑ A ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1 o 9A ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [I �f NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 3 No ❑ A ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes El No ;NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
d
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CJ 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
fo
❑ 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
EeNo
❑ 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
dNo
❑ 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

t
Type of Visit 7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 c7s Arrival Time: S Departure Time: County: 6 (A Region:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: &&&e I ?gZJSnA✓ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = ` = Longitude: = ° = 6 0 II
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1; 10 Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharaes & 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
❑
Dair
y Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: �i
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 0No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes dNo ❑ NA ❑ NE
❑ Yes �_,Wo ❑ NA ❑ NE
(11
12128104 Continued

Facility Number: — Date of Inspection 3 31 JS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:{,Ag-ov- 1166) 4(rooAl OLS
Y
Spillway?:
Designed Freeboard (in): e rn
Ob d F bo rd (in)• I9
serve ree a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
E4o ❑ 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 environmentaltheat, notify DWQ
improvement?
7. Do any of the structures need maintenance or El Yes
o ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
N ❑ 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
2 N ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) 164-1 IAA/1 /
13. Soil type(s) �Q L
14. Do the receiving crops differ from (hose designated in the CAWMP?
� s
[I No
[I NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
;Yes
❑ No
❑ NA
❑ NE
16. Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
o
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,L✓J
L' I No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
j(N o
❑ NA
❑ NE
/V Z,o) A/e,64 Jo vPO4Tt W Uf AND ADD SG v . WA NC76 5XE 1-0-3 1b C&P.r,
uPnAtE M090L.tTl rnAPJA&f060
13zm: b5S 6 F C Lao .r 6t o 0T ot,D LA 6 o o d .
159 F&Sw6 C.iEc,p nil-Fas w09-/C- 6?,/ 601-J �PotT -ffdD tJEE,Pt.
Reviewerlinspector Name :F'��' �' Phone
Reviewer/Inspector Signature: Date: 3 3 J 5
12128104 Continued

Facility Number: — 10 Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily avaiiable? ❑ Y s No [I NA El NE
20. Does the facility fail to have a components of the CAWMP readily available? If yes, check Yes El No El NA [I NE
the approprrate box. WWUp ❑ Checklists ❑ Design ❑Maps ❑Other
❑
❑
❑
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
No
NA
NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Xo
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
El
El
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
,E3!
L,YNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑4
❑ 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?
El Yes LJ
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes IJ 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?
,�
ElLd 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 PNo
❑ 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 V N
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional Comment§ and/or Drawings:
12128104

Type of Visit RrCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency eOther ❑ Denied Access
Date of Visit: Arrival Time: eparture Time: t ounty: � Region: _W,_ Q
Farm Name: Owner Email:
Owner Name: Z�ti5_ ✓ Phone. 2 �F
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 7 ��
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
Phone No:
Integrator• / /J 4eOG�*� Lj®
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ c = f = Longitude: = ° 0 6 =
Ig
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I� ❑ Non -La et
Other
❑ Other V
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Q—Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures: =,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(iel 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 t0 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
5No
❑ 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
GtJ`T +Gb.✓.�� �,C�O
Kid), e4� 6��G��n� (�R�s ��.✓� R�s��s �o,����o
-r ,SER vzc F i
Reviewer/Inspector Name'' r a ckF; Phone: �� s • d� .Z2
Reviewer/Inspector Signature: Date:
12/28/0 Continued

I
r .M
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ 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 Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.-
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ao
❑.NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
/UArpFnoQ z- Ze me 4,A&Ze o��s KLTs
0
141.,6az11 Sad e,%r
66lie
P*
_ W146iZ� V&ArJ HA5 6kF4,J MP,04741D 0-5 il4g 12/28/04
-MID AP

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: it
O Not Operational 0 Below Threshold
Permitted 0 Certified 13 Conditionally Certified © Registered Date Last Operat 5q or Above Threshold: .........................
Farm Name: .......`').Qt�...�x��.........F .......................... County:....(.................................................
OwnerName: ......1.... ��.......t.P�ZI`!,.�` i�................................................ Phone No:.......................................................................................
MailingAddress: ........................................... .................... . ................................................... ..................................................................................... ..........................
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title: .................................................. �ih�orne No:............................, ..................
Ii�` ..... V ntegl ator• ..... ..:1...................................... !..'
...................................... Operator Certification Number:..........................................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �" Longitude �• �' �"
y+i ,E , ">a t
! E rr ,t € Deslgrl it fCUI'Rxit�} ; , €kE';'€€ ` `i i7'!iE Design•Current I , }t b S 6� f } Design !t E ,;Current
dd t¢ j q{
E 1 1 3 .tt _
(( Ct f 1
Swine �a i;', .; r : t �.*St SCI� `;;PO u18tiOn�tiiPQllltry iC-3'i!,Ij�ig-eCi 9'E'6P0 III8tId1i 3iiiCattle, i,',I=�i.t9Eiu Q8 9ei �,:')p0 relation p-fl
fir. ` fi i
❑ Wean to Feeder °.�:iFEI
ayer ;, ❑ Dairy '
ceder to Finish on Layer JEINon-Dairy
Farrow to Wean 't jit
ai €i , 'i rH� r ihi9+C' t� r as } ' «`�
❑ Farrow t0 Feeder 1111€ ❑Other It,yE,C `3i €�'it'�l> ti. `� :* f s,�'itk! � z��
t
!t
❑ Farrow t0 Finish 6,1 I �r k rri Q� Design ,capaClty'I'
e it J+�i s<)u�'s u 1 ! + , t P tl ', 4 ' + r tr } t,
' ❑ Gilts E ' � tt �� +,�y �+ L it 1 ;• t ,� t ii I Et i - .�
❑ Boars � � f y , ."� r _ „r `# TotaI SSiw ` c�
.. " ....
of...
Number Lagoons
y § 14� t ilk t4
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (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 XO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................... .............................. ..................................................................................................................................................
Freeboard (inches):
12112103 Continued

PfiEility 1Qumber: & L 019 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes A!rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes �No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes PNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes VNo
11. is there evidence of over application? If yes, check the appropriate box below.
❑ Yes )dNo
❑ Excessive Pondi g ❑ PAN ❑ Hy raulic O erload ❑ Frozen Gr and Copper and/or Zing
12. Crop type1155nZ11-1c
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
0Yes,j5NoC, V
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 .dNo
16. Is there a lack of adequate waste application equipment?
❑ Yes.dNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes VNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VIVO
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'PING
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. /
n540 "3
(� DP s 1;5N
Field Conv ❑ Final Notes
Gas �fo �-fs
�zEGO. �iPo,�S
C�/%�� ��✓r'��fin t��—z�G- tic /�,�rOzr�D�✓rytC
Reviewer/Inspector Name J
Reviewer/Inspector Signature:
Date:
12112103 Continued

44cilltjt Number: — Date of Inspection
Reauired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
1Z
YNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes C3No
❑ 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 INO
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
'VNo
ZNo
(ie/ discharge, freeboard problems, over application)
❑ Yes
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 o
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
[]Yes Wo
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 ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
AV toy-- W N-5 Lc -z,� OAk) x�
f4--:5eae 5�%6C,o (10"1_4
12112103

Type of Visit 92rCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit CMoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number '% Q bate of Visit: s QZ Time: I N30
Q Not Operational Q BeIow Threshold
0 Permitted 0 Certified j3 Conditionally Certified © Registered Date Last Operated or Above Threshold: _ __._...- __..
Farm Name: ......... �.r�y....'U��! 2.sL'h �a"�.............................. County: _n j/o4�._..--•-----•-- .................
Owner Name: .---_--c="]-.1�rrts1-Y►------------------------------ Phone No: ------------ _._.--------------------------
MailingAddress: ......................................... ..............................................................................................................................................................................................
FaciI ity'Con tact: ...........................................................Title:............................................... Phone No:................
Onsite Representative:._T�'' -- :1? -f�'------------------------- Integrator: - Cq ro �t_-,A.4 /�or.Aq."O - --
Certified Operator:....................................:........................................................................... Operator Certification Number:...................... ...............
Location of Farm:
❑ Swine []Poultry []Cattle []Horse Latitude 0 • i 66 Longitude • &
Ca act P
Des n Current �, Caeaci I'o ul ent Design Current
SWne ' g o ulation Poultry g
ation ; Cattle • Capacity Po ulation
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish / Q ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean r, r
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts I „r n
❑ Boars , J Tbta� SSL' W
�„ Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
;Holding•Pofid9 /:Solid Trapsi 0 :�a ❑ No Liquid Waste Management System
Discharp-es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes V(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
I 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 ONO
I
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
41 Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
1 . Identifier; ..._..-- f-•------------ ........................... --........................ ......................... ............................. ...........................
Freeboard (inches); 3

UNDO/W
Facility Number:
Date of Inspection S O'2-
Lonrrnueu
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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADDlication
❑ Yes FRo
❑ Yes 014o
❑ Yes �No
01'es ❑ No
❑ Yes tf'No
10. Are there any buffers that need maintenance/improvement?
❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes ❑ No
12. Crop type Be r rn t/ d-, q r►s 5 G v e H�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Ma agement Plan (CAWMP)?
❑ Yes'JEJ'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?
❑ YesONO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
ryes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes Z No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes 2rNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes�No
24. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes ❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
xl��d µ� 'd^�'i�i' �' . Y� �I��dG-cM•..u...�Yfi!p�S�l�'R;.•�l 9�M°�%i �` �^'i`-�° � •p� Y Gdi �
Comments(referquestion�r/r�J`Ezpla�n any YSianswers,andYor anyrrecommendatians orMIME:any o hercomments
Use dva Inge ofgfacility 1'W CC ter expi4innsi
i��uaEio s.(use additional pages as nece "sary}:' ; ❑Field Copy ❑Final Notes,(
PI. Me, Zr;v)Sa,i T3 kecf t rep— ele60/d5 IiV4 IS �CGa1.�i0Yi6i�1
a, weck oil pose ir~ reaoed;�j i� ; meee( 4o be svfe 4a Aeg- �'�eeZ'a�d!
' ewide waakly . �1
lVd4e : Me. Brp"..r`f oll �a,Jo�� ,S dGS,'Jned jro� 35Z0 k)Oj.SG(�Opcgrt , b he
✓►
41 y b� Owe opuses �„ �h r_ete'l C' of %6a hays. n4�_ . '9,­;.,st7h
1S Go.nS/d�,rl+'1..� (�L•�Id;�+.�e-��...,a rn��'e 1�ausk5 •�e �teccSe �L,e ��alr'�io+��rl
t Reviewer/Inspector Name 'll.
�� Y•�.'.F '.`'1•I' d �11�j�� gx rT F' if
ri
, ti
Reviewer/Inspector Signature: Date: - r7 e2_
_.. �._�-.-.-... •...,n.�. .4..,. w..:_ �c...rri. •.u-�.•.•-.•-: u•.... Lxr �•riKKky}>:.'04'+!Xayn!A`.•.�-.wrnv:..r._�.�-rY+��.]3w1t'Y:.'��si:.�.w�•vr..[^:^T�q�r.w.xti.Lc4.4'rtJ..Yb:SI.Y•f[R^AS'Yr•.^,'.f:Tr,�...+-.�... ^.•M.: IA.r...yw�rr.......nrr1

e, 3
Facility Number: — (} Date of Inspection S� Z �� ✓
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?
Additional Comments and/or Drawings:
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes ONO
❑ Yes ZNo
❑ Yes fo
ElYeso
❑ Yes ❑ No
�a�-�:�.,,<�� � ���rt�f� cQ��►�,� A��-�aJ wa���. ������en� ���� and
v?'A61e wogs U i�iZq ;o►� plavl qnd glsa c4n167CJ Ae
f
tr w ile 4 v Q ,� !y
pe ,•1 V n t T
4�e E�0ld►�lo��l GL�p�IGi pf�er" ->l� Co�sJ`+rVG�ioY1.
1 � I
Need 4c, LAse 22.5 its1lieve 'PlrAn4 q✓a�Jq�[c IU ��Q+��n e)5 Ae
Vc) »t.✓L "ram, 1>41V G J J eyL-,n I GC Q+i 44e -�I�^
6enSt5I Or 2ov1Qf - kro•v �, G✓r✓em�l t�SpZg Zr7� 6v� nee
I
lo use 2Z5 gCGnrdr� 40 c.,�rh5fefl�� ,
Also, need 4e 6e .3 vre �,, r.,-se q �.v�s-rl� a#Itrl y5 dWed t,✓, :h
&O d,a�o 4,o edewli-,le 44a
op? -,Lte Z's . M.' . Sr +q4arn has Abe gn11 / .r,'r
by¢ needs -,e be o 14 r o� 411 Le —2Q<
S acrG } f
zs• m,.+, �r;nsa� heeds 44 be- sure 40 GUI bale, J re►l-vre
s► li ��of�n a"erseep�-6,9vvL llerds.
li3. Mom. �r�ns�� 1nof ceded 4kaf - t.,c be ('1oi41,1\5 e-,
cur• VVLA7 Lvroee q iiewe', l.vats�e p!a^ rr ki— -/,\ c-'v,q )need 'Sure
7DY ��� W1D.S3 feLerl� W�,,f�ci /J�ilh 10f �far'1+' >�LZC+�1t-7
el vet , (A (�! C "'0'? I 1
15. Sec-!rQr? E in �i�/d ? A�oPear! 40 .shty wGfgvtvf -/ +'1 w0.j
eqls.v ivod ctl4ed JV lrrlr. g,r;ns�i't; 4h,s mnt nab 6e su+44ble-Foy
Need 4e, con�aet .D►'jAricf And hei✓e a Proper erep For
pv� ►"n r.����ei��,,a eS��brf'slted �h ,�'�lr��,�ej;,�;-le
m 1s6, f ie iaJ !t,L a✓e byes;9 \A-feA for be+-►n✓dq. 7hefe it a end JAgiid
05103101 Dfe✓' 6r� v,(pt
awe ,e4 A e be,-m vote,
is lack►-�� ;� sarI e al-,W 161d i., reeef'v+'•`J 1 je'' `'7 o44e-r ore4s .
n04e Gempeai f �'0►1 4`4 beVer CS�IgM G, eh e q:re4y OfF..eras

el Paoc 9
Facility Number: '7 — �� Date of Inspection 5 OZ
Odor Issues
26, Does the discharge pipe from tkeconfincrincrit building to the storage pond or la to discharge atior below ❑ Yes [:]No
liquid level of lagoon or storage po with no agitation?
27. Are there any dead animals not dispose f properly within 24 s. ❑ Yes ❑ No
28. Is there any evidence of wind drift during Ian ph 'on? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public prope
29. Is the land application spray syste ' ake not located n the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major mai cc problems with the ventilation fan oted? (i.e. broken fan belts, missing or
or broken e(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 Comments and/or Drawings -
IS'. (C-0M }iyhvc��
�;�s irA has
P/srj 4ke Ief eve !nw lvel greiNs ill)'
W h; cll l re ne � cok7d ve; ✓e 4/- O f f f y ink w'A s�-e of
.1 Gfae , Need 4e, e)Ae✓ +1411fro e bra+'na�2 M-7o(
Crof 4r G11ar,✓ fo✓ a�i641 Fok� D44I'S fA14 1�ee6 j
-p1or► Glr+d ;rtG( 1,4c Laker access►'�1e lamed �1,�I 714�1 j ThiS Sq✓��
,f
✓'t?�GreYt Ce L�l�tS hitztd-e �dr ZOn i� Fiet{d .
g. � . Br i n�Qt� ;-Id -er? �e�l � rJ1d �hcre is eV IF deLice? I►, �►'t��G+C ~�� �
`1✓1
►] dlr�tn�s leq k bel'ole �n`t GlF�¢.� J s�c►� /S
y � �� t vmn «9 . liJeed
-la e1+,nrl;rt�,-�e lel"Cs ar,d �-C��n� ����{;..� candler eimoFt-
a�r welj4e. Con�at4 Till J4f eJp/ rnity yPl10 4,*�v� ;n
!
e, a-F� VglvVs itt Jeler� �14 cep.
25. 71,;s is ih ✓efGreh GCS 44 e AI J,'01r nzl�c I bo t4-� G U4;,i9) be?1 t'^1 �
� vt d -, C n-LO v ; +'t f 4-nrn a 1 / 7 - a i ✓I , N1 �3r : n s pra sFr a 00e( lrr -t.10 11 g �
A4,0( �
,u.A kerb-- c"I It- k"I'l ��; /►rJf 13ri.-.soh Aff/?'t
c,,JaS+e 4o -eke s,...ta? ( 9}}.-�r )� • ind " 61144 � 4tjO✓� 4-ItO ue'
!!Ye 1-�"
eYlov�i� SrYtal) r�rott-n TO ��I`+a . J-jdwev^2+' )7 UaG� �"DtaV Tv -?hP
Wr4e.- 'carat r�,�-tct,'.�ti n� degd SAP 5,ome Guru14�
IliVe 6ec.- Gv416,1Ied1 Ytd -ems✓ed.
a
05103101

.-t
Orbivision of Water Quality
Q Division of Soil and •Water ConsEervation
0, Other `
q..1..d
Type of Visit N Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
I)aty. of Visit- `3 a7 4 Time: � 3 3 0 Printed on: 10/26/2000
FFacility Number O
Q Not Operational O Below Threshold
'OPermitted [] Certified J3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
FarmName: "-e w � '':G.L-N............................................................ County. Qk:. ........................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................... ..........
FacilityContact: ..............................................................................'I'itle:..................................................... .. Phone No: .................................
MailingAddress:.......................................................................................................................................................... ..�.....
OnsiteRepresentative:................................................................................ Integrator: .... .1`... tv.........................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..............................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` 16 Longitude �• �� �66
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population. Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish rl,{0 ❑ Non -Layer In Non -Dairy
❑ Farrow to Wean
[:]Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes( No
Discharge originated at: [:]Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. ]f 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 galhTlin?
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
StRICtnre I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:............................................................................................................................................................................
i~rechoard (inches): 33
5/00
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 1�'No
❑ Yes 0 No
❑ Yes [�allo
Structure 6
Continued on back

aciilit�-Number: q Date of Inspection 0 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 01No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes gNo
(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?
It. Is there evidence of over application? ❑ Excessive Ponding `4❑ 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?
(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?
❑ Yes t No
❑ Yes 6fNo
❑ Yes )6No
❑ Yes #No
❑ Yes 9No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes r4rNo
❑ Yes ZNo
❑ Yes ONo
81 Yes ❑ No
❑ Yes ❑ No
❑ Yes (TNo
❑ Yes 9No
22• Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 14 No
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes "No
24. Does facility require a follow-up visit by same agency? ❑ Yes eNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes D No
�'VQ YiQlYwliegyegofrYer:o wtring�. s.vstl•eiuar.
• co! r oridenc, e: about this visit: • • • •
Commenti;(refer to question.#I): Explain any YES' nswers and/or any recommendations or any other coniiments
Use. drawings of facility, to better explainsituations. (else additional pages as,necessary)•
i-4(J�2 S Ajr
v�
LA
Reviewer/Inspector Name t.. "all
Reviewer/Inspector Signature: Date: "� —O`
�r -. , .,, 5100

IFaeility Number: — Date of Inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 4 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 eNo
❑ Yes trNo
❑ Yes O No
❑ Yes JdNo
❑ Yes pq
❑ Yes VNo
Additional Comments an or:' rawings:
AAA QL OVR—Ik"S�� K; I -N LAV%�' V"Z� "-�Vets F�'L�,
i 7
av- SL��.��-lwl �� o��� t��� �s� c`\ G.� �\SL•e�- �es
h�5�--ems �� � ►-�� a�-e�ee��t+� o� �e�-�� � be
n
C)'J-e—t-- It -�— '36 o
J
5100

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number ---
Farm Name:.
On -Site Representative: r 4 �-3ck
Inspector/Reviewer's Name:
Date of site visit:_1�]'`��_
Date of most recent WUP: q8
Annual farm PAN deficit: q93 pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility itern(s) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s).­ circle #: 1. hard-hose-raveler; 2. center -pivot system; 3. linear -move system;
0tationary sprinkler system wlpermanent pipe; a. stationary sprinkler system wlportabie pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map' depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigation operating parameter sheets, including snap
depicting wettable acres, is complete and signed by an I or PE.
V E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part 111. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part It. Complete eligibility
checklist, Part ll - F1 F2 F3, before completing computational .table in Part 11I).
PART 11.75% Rule. Eligibility Checklist and. Documentation of WA Determination
Requirements. WA Determination .required .because.operation .-"ails :one of the.eligibility
requirements iistedbelow:
_ F1 Lack.of:acreage_whichTesultedinzver ppplicationm7-wastawater�(PAN) on:spr-ay_
field(s):accordinQiodarm'saast-fwo-years:of:imoat Drizecords.-.
. F2 UnclearjIlegibie, :or lack of;information1map-
F3 Obvious -field iimhationS 7(n um erous:d itches idElLme:to:deduct?equired:.....-
bufrerlsetback:2creager-or25%:ofiotai_acreageidentifiedan_CAWNIP_.:mcludes _
small; -irregularly -shaped .fields - fields:less-than 5 :2cres�or..travelers_or.less than
2 acres-Ior.�stationaryspdnklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III.

Revised April 20, 1999
Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP FIELD COMMENTS3
NUMBER NUMBER',2 IRRIGATION ACRES ACRES %
SYSTEM
V
1
k '
E I 1 k k
FIELD NUMBER' - hydrant, pull, zone, or.point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation'system.- If pulls, etc. cross -more -than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination Tor exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBERI - must be clearly delineated on -map.
COMMENTS' - back-up fields with CAWMP acFeage2xceeding`75% of its totaLacres and having received less.than pan 50% _
of its annual PAN as documented inAhe-farm's-previous two years' (1997 & 1998) of irrigation -records; cannot serve -as -the
sole basis -for reauiring a WA Determination.hack-upfiieldsmust*be -noted in the-commentzectionand must -be accessible
by irrigation -system.
Part IV. Pending WA Determinations -
Pi Plan Jacks.followinginformation:
P2 Plan Tevision -may:satisfy7.5% rule based on adequate overall PAN deficit and by
adjusting -all field -acreage _to -below 75% use'rate _
P3 Other (ielin process of installing new irrigation system):

Routinc 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number O Date of Inspection 19 Oo
Time of Inspection 1 V3 t,d 124 hr. (hh:mm)
Permitted © Certified 0 Conditionally Certified © Registered Not Operational] Date Last Operated:
Farm Name: �e.► Y ��� .....................I... County:.... h3. C:� `'..............
OwnerName......................................................................... Phone No:.......................................................................................
Facility Contact:.............................................................................. Title:................................................................ Phone No:
...................................................
MailingAddress:..................................................................................................................... ................ ..........................
Onsite Representative: „ �,,-1 t^`�r Integrator;,,,,,,,,,,,,,,
Certified Operator: .................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
............. I..................................................................................... ............................................................................................:......................................................................
.....
Latitude =" Longitude
wine' P ry_Capactty PCP rrent Design I Current
'Design ` `-Current Design
I oult Cattke
Ca" 'act ' "`Po elation o ulatton
— — — ,F..-. C4pacl, 1?opulatiuti
If'
❑ Wean to Feeder
Feeder to Finish
Q
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
❑ VOther €
Non
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. Il' discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: `
Freeboard (inches): .............33...............................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
% No
❑ Yes
5rNoN
❑ Yes 9No
Structure 6
❑ Yes WNo
Continued on back
3/23/99

1
Facility Number: 6� — g0� Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
KYes
❑ 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
KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
V No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
bdNo
11. Is there evidence of over ap lication? ❑ Excessive Ponding ❑ PAN
❑ Yes
MNo
12. Crop type S wo',
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
b) Does the facility need a wettable acre determination?
❑ Yes
[M No
c) This facility is pended for a wettable acre determination?
❑ Yes
IN No
15. Does the receiving crop need improvement?
❑ Yes
CgrNo
16. Is there'a lack of adequate waste application equipment?
❑ Yes
MNo
Reouired Records & Documents
IT.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
N'No
r
18.
'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
fYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time,of design?
❑ Yes
WNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
W No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
kNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
t�No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
n(No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
MNo
llp.K45,t,OkNtgs o dg�c�encie vt'e �ijte�l daring th}s'vlislt: Yoh wi��eegiye tjo; Ifu her -: -:
coabout: this visit. :::.. . ..................::::.::::. .
If)
TA<_ k. 84�,A aL-� J
AA PAR
�1� � s � yoL.,l G►'Ci�%, ��� �
Reviewer/Inspector Name ',_; '�,�7.7777ai'r %r a�� ;� �(3_ 51
Reviewer/Inspector Signature: Date: — 151•-00

J•
Facility Number: 69—
Datc of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
xNo
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
Wo
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
JXNo
30.
Were any major maintenance problems with the ventilation fan(s) noted?. (i.e. broken fan belts, missing or
broken fan blade(s), inoperable shutters,
❑ Yes
XNo
or etc.)
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
XNo
itiona omments an
•i.. ,. � �.�..��.or
raw�ngs
.,:.,.z
a {
Ale-
3/23/99

0 Division of Soil and Water Conservation O eration Review
P
-D Division of $oil and Water Conservation Comphanc@ Inspection
Ft rita
s r , I� r i j ,D1VIS10n Of iWaEeriQUAhty COmpnCe �[15pCCtlOI1
r a� Other Agency,- Operation tRevkww -`' EI r
140 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-ug of DSWC review 0 Other
Facility Number d Date of Inspection
Time of Inspection 24 hr. (hh:mm)
UPermitted ❑ Certified MConditionally Certified (] Registered 113 Not Operational Date Last Operated:
Farm Name: . P-91...... .................................................. County:.. ICU 1..2C1
Owner Name:....PY�.y......._l.!`.C)............................................ Phone No: ' et 1.°....�a.. "..✓�0�.5
FacilityContact: .............................................................................. Title:................................................................ Phone No:
...................................................
,Mailing Address: ..4..7..!...... Frza� R.W.q..................................... ..F—A(41LA P0.S.......N4%............................. ..�'1..-57..7 4...
Onsite Representative: ......................................................
Certified Operator: ...Ir-2.`rf......A......
2.1..!`i.5al
Location of Farm:
...... Integrator:... .tA.:t ..Qf .F............... ........................................................
Operator Certification Number:.....j.lD Z, I„
. a. r h.....P..l ...*'4..'......�:.�......t�'.....�R:�.....P..r�...F..t� D....11r`.. �� �s �T� o ,., ...F..11 w.J...Z Q:...A.0.4......t�!�.y..
................................. ............................ ....... ................. ........ T
-01
Latitude ® ®� 33 Longitude 0' F3 ©66
Design Current. Design Current "' " Design Current°"
.i �,,.,g _ ,��._
Swine Ca acit Po ulation Poultry Ca acrt . Po' ulation " Cattle Ca acity .Po ulatiom`
❑ Wean to Feeder
[&Feeder to Finish
j (D 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer x' ❑ Dairy ,
❑ Non -Layer ❑ Non -Dairy
❑ Other
' Total'DcNign Capacirty 6 O
Total SSL'Wi
t�,
�X' ESN-bmberFof'Lagoons ® Subsurface Drains Present ❑ Lagoon Area ($'Spray Field Area
Holdrng;Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharge- & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes b�No
Discharge originated at: ❑ Lagoon ❑ Spray Field [-]Other
a. If discharge is observed, was the conveyance man-made'? El Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in 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 nNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes NEYNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches):............................................................ .................. :................ ................................................ ............... I......
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3/23/99 Continued on back

FacMy Number: — 6 Date of Inspection
✓ 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? ❑ Yes 5�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 M .No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes tErNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes &0
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [�10
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes pll�o
12. Crop type � o,e,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 5<No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes t4No
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
Re
uired Records & Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
kINo
18.
Does the facility fail to have all components of the,Certified Animal Waste Management Plan readily available?
�,T
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
1=J ISO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
j4Na
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21.
Did the facility fail to have a actively certified operator in charge?
El
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
JqNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
(YNo
1-1
24.
Does facility require a follow-up visit by same agency?
❑ Yesr(No
�
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KN0
Rio •viola(idris ;o;r• & ieieacies -NtF Nr - h0f d. d(rrfng 4his;visit; • Y;ou will •i•eegiye Rio: futthgtr
comes ondeitCC. ahotit. this .visit: .. ' • ' ....... .
Comments,(refer toiquestion #) Explain any YES f answers "d/or�any recommendations or any othger comments i t
.. , 4 Eu-:.�,
[1se;drawtngs of facility to Setter explain situations (use additional pages as necessary) y t 1 F
€firm n• _ r - 7tiF^- r�tl f S ,� e� 1'� to 1�� r a !
ReviewerlInspector Name r t t cif -d t - 1 °i i � ,� ,;:���� i , .� �?(
Reviewer/Inspector Signature. � Date:
3/23/99

Eaf-iHty Number: r0 — 8d I)ate of Inspection
}• `""7" 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes LNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours'? ❑ Yes YNo
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 t❑ 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 �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes >CNO
., iti�ona ,omment$ an, <„ oC r rawing§>., � dl-n, �,:. i,d .1 �. ,•3 „� ,� 11 p }. , .� „r �%N c.�.EE i, �.�-t,�. 3� _ i..,ir: .f aII I(r��:t i I �':3:•.' <A>> _. .. - .
3/23/99

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
is Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number —�
[Time of Inspection / 24 he (hh:mm)
0 Registered prCertified E3 Applied for Permit Permitted [3 Not Operational Date Last Operated:
Farm Name: ...... 1.0�.ieeeyy..p.......Spzaj..:� 5.pn ....... ?! . l ....................... County:........QG/�/. .> kl/......................................
�t Owner Name:.................../5klzy:7S....................................... Phone No:....cl? ..7—w�r%...tR.....................................
Facility Contact: . Title: .............................. Phone No: ... 3.1—,j a 3
Mailing Address: .... 7....%........ ....... ........... /.w ,,ww ,.ee.jal...... N...0 . ...............................
Onsite Representative:...... rC%2/L.V...... /.�­"/..,ej._s..g.N............................. Integrator:............ %E! l.H..P....o.f........................./..........
eratort... p T Certified O .... Operator Certification Number;....�.lR............
EiZR..y.,........b2�................. .........................I...........
Location of Farm:
Latitude [�* E_57�, =,, Longitude ®• ©1 =11
�.
Design - ,Current, - - Design Current Design Current
Swme Capacity Population Poultry Capacity :Population Cattle Capacity Population; '''
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish % ILI Non -Layer ❑Non-Dairy�" ❑ Farrow to Wean
.;. ❑ Farrow to Feeder ❑Other;,
❑Farrow to Finish ;Total Design Capacity `;
❑ Gilts
❑ Boars F a Total SSLW
Drains Present
❑ No Liquid Waste
General
f. 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 gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
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 4No
❑ Yes*No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �Mo
❑ Yes , `�No
❑ Yes NrNo
❑ Yes R No
❑ Yes RNo
❑ Yes 5
0
Continued on back

5
~ l F acility N umher:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Iiolding Ponds, flush Pits, etc.)
9. Is storage capacity (freeboard plus storm. storage) less than adequate?
Structure 1 Structure 2
Identi her:
......................................................................
Freeboard (ft): ........ ��.........................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4
.......... ........ ........... ... I ....... I ........ I ... I ... I
11. Is erosion, or any other threats to the integrity of atiy of the structures observed'?
jVrYes ❑ ,No
❑ Yes kNo
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?
Waste Application
W. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type 51h:`Y....I-MIn... 7..` 4_5 .... I...r#...a................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management flan (AW,MP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative`?
22. Does record keeping need improvement?
For C'ertitied 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?
...........I .....................
❑ Yes
Vq No
❑ Yes
Wo
❑ Yes
❑ Yes No'
❑ Yes 4 No
,Yes
❑ No
❑ Yes
NrNo
❑ Yes
"No
❑ Yes
,NrNo
❑ Yes
kNo
❑ Yes
kNo
No.violations or deficiencies.were�noted during this:visit..You.wi11 receive no ftirttier
correspondence a out this
❑ Yes �rNo
❑ Yes �vo
❑ Yes ANo
❑ Yes D(No
Commenti (refer to question #): -Explain any YES answers and/or any recommendations or any gther commenits
Use drawings of facility to better explain situafidn.4 '(use additional pag s'as necessary).,:;:
7/25/97
Reviewer/Inspector Name f, r �;d.P tv7 � c
Reviewer/Inspector Signature: C,l//„� Date: /D

J
.... :,::,..... _ .......... _ �.......
❑ DSWC Animal Feedlot Operation Review
�N [RDWQ Animal Feedlot Operation Site Inspection
4,�
r �r'�;;; :: 4�'r. t: e, ....: , -.: .:.:..:: ry..n..�-w.,: ur: : v.!.wrn:... :,...:,<: :»., .::. :.. r.. ..v ..... v. ::✓,;,. :.:.ow..�.,: ._uea �.w.�<. Y�t'(�6 t� FPo �; N l Hof
Routine O Complaint O Follow-up of l)WO inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection Z7
Time of Inspection 0 24 hr. (hh:mm)
Registered JQ Certified [3 Applied for Permit E] Permitted [3 Not Operational Date Last Operated:
1
Farm Name...71.11 r`I�irt............. .L t' 4? �........Y .�'4! I :.......... County:.....,.. c1 f4. [IJI.r.. ................
OwnerName: ....,�,�.e f1 ... ... .......................... Phone L............�.3.�...,.......,..................,...........
Facility Contact: ......�....Sr.Qi,r ........... .....e...................... Title:-Q.l:,ti1...ly. � ..... ........ Phone No:..,.......`.......................................
Mailing Address:....,�.i............... kiW. W.-Al ............ ........... .................................... ...��C..�..%.�
Onsite Representative:77Piek-1..................... . Integrator:... .�j�..> ...-�� ....
Certified Operator--. ... 5.:.�-- . .........- ............ .. r►.�rrt"!-� .. Operator Certification Number,.....:.[..1�..�..3 f
Location of Farm:
C
C
Latitude 0 1 44 • Longitude 9 6 14
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
-35
11(P0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design „' Current
Poultry Capacity Population Cattle Capactty'Population
El Layer ❑Dairy
❑ Non -Layer JE3 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
g f �� g pray Field Area
Number of Lagoons / Holding Ponds j bahsurfacc. Drains Present Lagoon Area S„
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement'? ❑ Yes
2. [3-150-
Is any discharge observed from any part of the operation? ❑ Yes [9-No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, watt the conveyance matt -made? ❑ Yes ❑'N
b. If discharge is observed. did it reach Surface Water" (If yes, notify DWQ) ❑ Yes 0-1<0
c. 'if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Il' yes, notify DWQ) ❑ Yes U-116
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 9-lVo
4. Were there any adverse impacts to the waters of the State other than from a discharge'? ❑ Yes [Wo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes G3-No
maintenancelimprovernent'?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 01-No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [9-1Clo
7/25/97 Continued on back

Facility Number: — C(�
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Laeoons,Holding Ponds, Flush 1'its•_etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
ldentificr:
............................................................................................................................................. .............................
Freeboard(ft): ...........t..0.......................................................................................................................... .... ....................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12, Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application`?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
J
15. Crop type...........�k...�.....b_...................................... .............. c Lk.�_ ..................... �� .:... -.:...........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24, Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
0 No.violatio`nsor deficiencies we're- noted -during this;visit.- .You.wi11 receive no further
cotOe Ondebce about this.visit:.
®ems ❑ No
❑ Yes (moo"
Structure 6
❑ Yes C3<o
❑ Yes Eg-hto
❑ Yes ER -No
❑ Yes 0.901
❑ Yes [}4do`
❑ Yes GINT
❑ Yes [l-Pt-o
❑ Yes UNo
❑ Yes 2'lgo
❑ Yes 0-f I-0—
❑ Yes [A -No
93'Yes ❑ No
❑ Yes Q'No
❑ Yes Rli o
❑ Yes ❑,190
Corninents,(refer 'd question #j: Explain any YES answers and/or auy recommendations i t any other -'comments.,:, . „ "
Use drawings of facility tu`hetter explain situations (use .additional pages Ws. -necessary)., d . ,
i rf1G I i S
0y ,
alp TAA-r)NU A`�'6 O7Z e-9 p.4C. 4.
A V P A A S AJLFT NLt:t ,tJ
TO 5?"�
s A) O
S'PR. �� [.� to PS • (,(/ A 5"C 4 P IA.J
A
Alt i—t+4 D•
7/25/97
Reviewer/Inspector Name
Reviewertinspector Signature. Date: