670084_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: Co pliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visi : 0 Routine 0 Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: S� �� Region: V v ` eo
Farm Name: riOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �Avfn' . svo
1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: C� 0 $ 90--
Certification Number:
Longitude:
Design Current
Swlne CapacitIt op.
Wean to Finish
Design Current
Wet Poultry Capacity Pop,
La er
Non -La er E�]
Cattle
DairyCow
Design Current
Capacity Pap.
Wean to Feeder
DairyCalf
ceder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P,oultr C►.a aci I;o ,Le
Layers
D Cow
Non-Dairy
cker
Gilts
Non -La ens
der
Boars
Pullets
od Cow
Other
Other
Turke s
Turke Poults
Other
Discharses 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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
Page I of 3 21412015 Continued

liacili Number: - Date of ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ONE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 PKQNo
❑ Yes PZNo
❑NA ❑NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �jy;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 A No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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 J?�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes *o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes ❑ No
❑ NA
[j NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
I —]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 14
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 No ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili 'Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes &No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes X 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 �4 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No XNA ❑ 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? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 9No ❑ NA ❑ NE
Comments (refer to question #) Explain any.YES answers and/or any additional recommendationsior any other Acomments.
.
Use drawings of facility t6 better explain situations(use additionai pages as necessary). ' a
�... �..
❑ Yes No ❑ NA ❑ NE
❑YesNo ❑NA ❑NE
c+,wrMj
CyUy-A �V1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes m No ❑ NA ❑ NE
❑ Yes �4 No ❑ NA ❑ NE
�n rem -ohs
Phone: 576— I & —730
Date: / I
1412015

Type of Visit: Q'Co ance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: aRoutine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access {j
Date of Visit: i6 I Arrival Time:F-77-95-7 Departure Time: / cJ A County: Region:
Farm Name: ��r� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: C rl S Mr' n S P^
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
­Z�az2-
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design
Wet Pou
Current
Design5*"ent
CapPop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
)Lno
llesign
Dr,Y P.oultr, Ca aeit
Current
P,o P.
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Othe
L_LOther
Pullets
Beef Brood Cow
Turke s
urkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State`? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 Io [DNA ❑ NE
0 Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection: ! ('
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2�No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VTNo ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes eNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ 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 6 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ffNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
OfIN10
[DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ej^`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
eNo
❑ 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
E�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZD 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 N/o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes lo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: T, 7 - Date of Inspection: Z
2,4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E2fNo ❑ 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 2<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [ff'N--A ❑ 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?
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes Ef No ❑ NA ❑ NE
[:]Yes 0No ❑ NA ❑ NE
❑ Yes <o [] NA ❑ NE
[:]Yes �No [] NA ❑ NE
❑ Yes )'""' % ❑ NA
❑ Yes 7777"``"""""'' ❑ NA
❑ Yes�`N[:] NA
Date: -'�� �6
21412015
❑ NE
❑ NE
❑ NE

Type of Visit: CwCompli nee Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 0— County: 0r) 5(0L- Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative:Integrator:
Certified Operator: Certification Number: `2 OW22-
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Desigu Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
I
Dairy Cow
Wean to Feeder
Feeder to Finish
III
5 47 2
JNon-Layer
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oultr. C•a aci P,o
Dry Cow
Non-Dahry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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 E]-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[► rNo
❑ NA
❑ NE
❑ Yes
[:fNo
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Facility Number: rR7 Date of Inspection: j
Waste Collection & Treatment
4. Is storage, capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-R10 ❑ 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):
G
Observed Freeboard (in): ?� -
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
Q No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[T No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]'No
❑ NA
D NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[6 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [t No [DNA ❑ 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): SG 0. G(p
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [:]'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3"Ko ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
<0
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
BNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections ❑ Sludge Survey
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 9 No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ fo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o
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 allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [/] No
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes C�J`No ❑ NA ❑ NE
❑ Yes [2fNo ❑ NA ❑ NE
[:]Yes ffNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [3/No
❑ Yes No
❑ Yes 9No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as`necessary ).
Reviewer/Inspector Name: 1)& -"7' J e o'-f— rl Phone:
Reviewer/Inspector Signature: Date: S ��
Page 3 of 3 214 014

for Visit:
Date of Visit:
Farm Name:
0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Arrival Time: Departure Time: County: Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: VW-a4T_s kk z.*J,50� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 20 -3 2:2::� —
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design C►urrent
DesignMPIOP.
Wet Poultry Capacity Cattle Capacity Pop.
La er Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
`
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
ult. aaci Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
El
Pullets
Beef Brood Cow
Other
rke srke Poults
touther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑K/N/,[]
❑ NA ❑ NE
❑ Yes l NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

facili Number: -1 Date of Inspection;
Waste Collection & Treatment
14. 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
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IdNo ❑ 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
1 �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
reat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
;jNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
z2Z❑ 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):
U. Soil Type(s):
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
'No
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E� ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
F] 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
011C ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EKO ❑ 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 ['j,X6' ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NoI NA ❑ NE
,-623. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

tFacitity Number. - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
R
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [D-K° ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes E3 o ❑ 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)
❑ Yes C?<o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes <o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
%
D40❑ 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
��/00❑ 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
Phone:
Date:
2/4 2o1

Type of Visit: V Co pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
I�IY�I YIIIII■ _
Arrival Time: ® Departure Time: ® County: (A Region:
Owner Email:
Title:
Phone:
Onsite Representative: m6g=5 13c�-r►.��o'<.� Integrator:
Phone:
Certified Operator: Certification Number: 20 g��
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
I
airy Cow
Wean to Feeder
I
INon-Layer
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dray P.oulh.
Ca aci
P.o P.
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ONo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
] o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
-No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - X Lf jDate of Inspection: a7
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1, N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? a—y—CS-161/No ❑ NA .
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA
❑ NE
�Zo
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)
No
9. Does any part of the waste management system other than the waste structures require ❑ Yes [] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA
❑ NE
❑ Excessive 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 Typc(s):
13. Soil Type(s):
M. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZT
❑ NA
[3NE
l5. Does the receiving crop and/or land application site need improvement?
❑ Yes rN
❑ 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 hTo
❑ NA
❑ NE
l8. Is there a lack of properly operating waste application equipment?
❑ Yes [/No
❑ NA
❑ NE
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: JDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ZN9❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes YNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 4� "" ❑ 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
❑ Yes
rNo
❑ Yes
❑ Yes E No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [7�No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ 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
Phone:
Date:
4/2r7 1

Type of Visit: (Z) C pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: d ,/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Al a_7'P( B fj4) Integrator:
Certified Operator: Certification Number: a
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
DesignmoluN
Swine Capacity
Wean to Finish
IDesign Current
Pop. Wet Poultry Capacity Pop.
er
Design
C►attle Capacity
DairyCow
C*urgent
Pop.
Wean to Feeder
ELa
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,oultr, Ca aci P.o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
keys
Turkey Poults
Other
Other
Discharges and Stream -impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: (pZvi
Date of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2/No ❑ NA ❑ NE
V
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): 'Jl�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I&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 C No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
N
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 VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
No
9. Does any part of the waste management system other than the waste structures require
[] Yes
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes &No
❑ NA
❑ NE
❑ Excessive 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes rl�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes To
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes To
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑ Other:
21. Does record keeping need improvement? 1f 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 Wo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 6;"O/
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA ❑ NE
Zo
25. 1s the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
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
a o ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesFNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes
❑ NA
❑ NE
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 addition al,pages as necessary)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Date: 9-JiSI/2-1
Page 3 of 3 21412011

Efhcifity-,N6'mbe�r
l "L
m of Water Quality :
�n atSoiliand�Water Cnnser�vatio
pxArytia `a
hype of Visit
Co pliance Inspection
Operation Review Structure Evaluation
technical Assistance
Reason for Visit
outine O Complaint
0 Follow up 0 Referral 0 Emergency
0Other ❑Denied Access
Date of Visit: ��}liJi Arrival Time: ® Departure Time: County: QIt S_L4G% Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Motitt�s 4�-Sa.1S6�J Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = 6 = Longitude: = o =,
-':;.�° 't:'a, g,a ; :.i_-:a�3 - ::s'pa'}w.:$< 1�y�.'rs,
a `.' Desi n Current ` • l . i : �� Dessgn}`q:x Current ;'t ,�Design,"lCurrent t
Vl-
j i� } ' k.'a? k% .,r.: L1' A t,` & z.�.4& s `x t ' ark�.
ne <Ca sett "'o Mahon :: Wet 1'aultry �'Ca act pPo _ulation Cattle � �•
f, t P . , 1 p... P y., „.P art t, s�.r :.CapacityaPopulatton
i ❑ Wean to Finish :❑ Layer
❑ Wean to Feeder �` ❑ Non -La er
®FeedertoFinish aat�ct s'�e"�s
❑ Farrow to Wean
�* ❑Farrow to Feeder •k:; Y.x�. y. !s r,,.. ;`
t'
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
t'.t�Turkey
AD Other �'s�IVumbeof Structures
a°��?.i:°t;'� ''•, ,. ti `
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Points
❑ Other
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ NN ElNA
❑ NE .
❑ Yes
❑ Yes
L� No El NA
ElNE
❑ Yes
3/No ❑ NA
❑ NE
12/28/04 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?
Struct re 1 Structure 2 Structure 3
Identifier: C ACJQG
❑ Yes U No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [/No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t cat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No [INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes D/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 EJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
3
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
LJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ENo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Comments (refer to question ¢ # ) Explain, any YES -.answers and/or any recommendations or "any other comments '
Use drawings, f facility to beftcr explain 'situations: (use additional.pages as necessary):
Reviewer/Ins ector Name
P Phone.
Reviewer/inspector Signature: Date: 3 d
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection 4 tl
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
❑ Yes IQ No ❑ NA ❑ NE
❑ Yes f No ❑ NA ❑ NE
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
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,�,/No
d No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�TXNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�zo
❑ 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 Io ❑ NA ❑ NE
and report the mortality rates that were higher than normal? X
30. At the time of the inspection did the facility pose an odor or air quality concern'? ❑Yes C No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
N
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ 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
L�J N
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
AdditinnalCornmentsend/o'r;Diawings::' °' k.. ,b �,a=a,'�a'kf?�iIT t���`.�
O
Page 3 of 3 12128104

go
Type of Visit dcompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (✓ Routine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Ur Arrival Time: /bd d Departure Time: County: $4LOLJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: M4,t&-ZL- 6A= [0J Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = ' = 4f Longitude: = ° = t = 6f
Desi21MYROC',
nt Design Current
Swine Capaian
Wet Poultry Capacity Population Cattle Capacity Population
Finish
❑ La er
❑Dai Cow
Vto
to Feeder
❑ Non -La er
❑ Dai Calf
r to Finish
J21—Lt LA x
2.9zo
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Layers
❑ Farrow to Finish
❑ Beef Stocker
ElNon-La ersEl Pullets ❑Beef Feeder
❑ Beef Brood Cow
❑ Turkeys
Gilts
EBoars
Other
❑Turke Points
❑ Other Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
[3 NA
[I NE
El Yes
,❑,
LANNo❑
NA
❑ NE
❑ Yes
LS No
❑ NA
❑ NE
12128104 Continued

1, facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA&dwtJ
y Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
7No
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
ld No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EdNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
/
(�,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
1
E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
t3. Soil type(s)
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
a]
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
!f, No
[I NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El YesWNo
o
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
'..e:. ' sa&�,r
,'Comments (refer to question°#).� Explain any YES answers and/or any recommendations orco ,any othersmments
Use drawings of facilitykto better explain situations. (use additional pages as necessary):
y
�-. tT�A�� 9' � Y ii' k
Reviewer/Inspector Name. £' } V' r Phone:
ReviewerAnspector Signature L D.
Page 2 of 3 lL/Lo/VY %lurifirl"C"

ti
Facility Number: (p7 —lgq Date of Inspection b
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Jlo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C1 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?
ElYes
C2 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
o
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,Cl
EJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
_C-,Ko
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,_
3*
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,Eo
LINo
❑ 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
Li 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
ElO Yes
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�,��
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElE Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
04)
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Il bU Departure Time: County:—!1l✓JL-0W _ Region:
Owner Email:
Facility Contact: ,,MM Title:
1►1
Onsite Representative: _ 6� 160-�NSdtI
Phone:
Integrator:
Phone No:
Certified Operator: I Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 6 01$ Longitude: = ° = t =
Design t±urrent
Mill'
Design Current
Design Current
Population
Wet Poultry Capacity Population
,...
Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
600
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Layers
❑ Farrow to Finish
El Stocker
❑ Gilts
El Non-LayNetsers
ElBeef Feeder
El
El Boars
❑ Pullets
El Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures: a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ 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
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Cl 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: — Date of Inspection o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (A66�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes Q`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 ONo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ZNo
❑ 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
No
7. Do any of the structures need maintenance or improvement? ❑ Yes
O
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
[ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
4 -N/o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
��,,/�
L`7No
❑ 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
Eallo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
,[�o
{ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9,No
❑ NA
❑ NE
. ...�a.x, .a. '"s i?'::" 1�i n"i.e`�sg� � �y_ ir:€4:,i�"t'ci�'€'',� *;�-�3` :P�=� '�
Commentsr(reiert to'questton-#) �Ex. loan€any YES answers and/or anay°recom��yi�bndations orxany'6t�hIert;coggmgmengts„
r°Tiy r•.J .J 4 y3._.<4 _�;sa-�.17 4. :A'I.s,"€5 i .�: ':8�.',:�gtr1H's&�. k i�"�&'�'.4.i:. :,i`'i. Y T :..`WR Y..,c,* L',». ! Tve i.5�}:i
ruseYdr,.awings of facilttyto tietter£explatn ttuattons.,(use{uddittouaI pages as.necessary):-' 44.- ., ,a.� t; �t 4 }
srb6XVv6
-
,U)..UroArt
F��C CpGt8iU4F-�'� j✓�6�N �EG���b
T
Reviewer/Inspector Name �` JdF1nL Phone:
Reviewer/Inspector Signature: Date: r 0
Page 2 of 3 12128104 Continued

t
Facility Number: — Date of Inspection 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ MaP s ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Applic tion ElWeekly Freeboard ElWaste Analysis ElSoil Analysis ElWaste Transfers
ElAnnual Certification
ElRainfall 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
0No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
G�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
G3 Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZNo
❑ 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
E(NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ld 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
ENo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0No
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
dNo
❑ NA
❑ NE
Additional Coin'ments and/or Drawings:
Page 3 of 3 12128104

e i t
Type of Visit Qf 7Routine
llance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reasonfor Visit O Complaint 0 Fallow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 17 U Arrival Time: ! 23 b Departure Time: County: aW��� l+� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �pQ Title:
Onsite Representative: �U�s ✓Z7t2.�l1�.f 11f�
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = I =" Longitude: = ° 0' = "
Design Current
Design Current
Design Current
Swine Capacity Popuation
Wet Poultry C►apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
7J5�
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non-ts ers
El Beef Feeder
❑ Boars
Pullets
❑Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
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? (Ifyes, notify DWQ)
❑ Yes ❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there an adverse impacts or potential adverse impacts to the Waters of the State
Y p
❑ Yes o
ZN
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12178104
Continued

Facility Number: 67— Date of Inspection 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'V7
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes U No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
ltthrr t, 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 64)
❑ NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
i�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ElNA ❑ 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
t2. Crop type(s)
t3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
t5. 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
i/ o ❑NA
El NE
NA
❑ NE
M [I NA
17❑
❑NE
NA
El NE
No ❑ NA
❑ NE
t"•nrnments {refer to question #.}: Explain any Yl1S answers and any recommendations ar any other comments.
Use drawings of facility to better explain situations. use additional pages as necessary):
ALI
-:
aReviewer/Inspector Name Phone: .�
, �
Reviewer/Inspector Signature: Date: f !
Page 2 of 3 ' 12128104 Continued

Facility Number: — Date of Inspection 8 7 OC
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑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 t" 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install.and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L o ❑ NA ❑ NE
25. Did the facilityfail to conduct a sludge survey as required by the permit? ❑Yes �o ❑ NA ❑ NE
$ Y q
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No 7NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
V� ❑ NA
❑ NE
❑ Yes
f_'J No ❑ NA
El NE
❑ Yes
� ❑ NA
❑ NE
No
❑ Yes
Q ElNA
❑ NE
El Yes
[3 NA
[I NE
❑ Yes
L No ❑ NA
❑ NE
Atltlitionai Comments and/or Drawings ?+ ,� 3`�1xr ">
r
T
Page 3 of 3 12128104

,�� J
Division of Water Quality
Facility Number {ate] W-� 0 Division of Soil and Water Conservation
.0 Other Agency
Type of Visit eCompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: O/VSL,AO Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: M­t—n-,�;% Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 ' = Longitude: 0 ° ❑ ` = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish L4 $ 00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design, Current I
Capacity , Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
LNo
❑ NA
❑ NE
❑ Yes
U�No
❑ NA
❑ NE
12128104 Continued

Facility Number: G Date of Inspection
Waste Collection & Treatment Er'
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LACt"a a 0
Spillway?:
Designed Freeboard (in): 110
Observed Freeboard (in): 3 3
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.) dNo
6. Are there structures on -site which are not properly addressed and/or managed ElYes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes l—✓! No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ENo ❑ 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�o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
C�'No
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
C]'No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes '
l_'7 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facilitybetter explain situations. (use additional pages as necessary):
/to
0 1041-6
�5l 6LVV 6 F SURVEY 00e,1E C-6 i U 14n/v} FAY-.
Reviewer/]nspector Name �nL Phone:
Reviewer/] nspecto r Signature: Date: 3 za o
12128104 Continued

Facility Number: Date of Inspection 'to
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fNo ❑ NA ❑ NE
20. Does the facility fail to have components of the CAWMP readily available? If yes, check lJ Yes ❑ No ❑ NA ❑ NE
the appropirate box. El WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (Ko ❑ 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 WJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [I NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El
No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ETVes ❑, NoElNA ElNE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes o ❑l NAElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElYes ElE No NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes D-1qo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0-go-
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E'lqo
❑ 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
[I 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
0 No
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ErNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

v
,Facllity,Number;� �7 � .��
(Division>of.Wiiter Quality,,'
Q Division`of Sou and Water:Conservation
Other'Agency' V
Type of Visit 0 Com Hance 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: 116b 7 Departure Time: County: D t Region:
Farm Name: Owner Email:
Owner Name: Phone:
,t
Mailing Address: 1
1
Physical Address:
Facility Contact: 'Title: Phone No:
Onsite Representative: MOa/ :13 f3ttmN50 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design �Eu
Capacity Pbpt
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
I 7_, 44 T3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Back-up Certification Number:
Latitude: =] o =]' = Longitude: = o =' = "
Dry Poultry ❑ Dry Cow
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
!' U Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures � '
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes Uo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑N El NA
❑NE
❑Yes
El Yes
No ❑ NA
❑ NE
❑ Yes
L.j'No ❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Zo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [:3 Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
es
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑Annual
Certification
❑ Rainfall Mocking [Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
El No
C❑
E�
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
L"J NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E 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
2/MO
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
[3 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
EK
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�
IJ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

acitity Number: — Date of Inspection !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes d<0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[]Yes ❑ No ❑ NA FINE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:LA G *0PJ
Spillway?:
Designed Freeboard (in): Z-10
Observed Freeboard (in): �d
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
El Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes L'I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes [2/No
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) r
4. Does any part of the waste management system other than the waste structures require
El Yes Z/No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) lb L)'L) Sb 6
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [27N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes No Yes ❑ 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 26VNo
El NA El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ 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):"
Cn.oe YS&-L D uP OATr--p , GEr 5 TOVCXW,- nr o t-&O -A.—
`
Reviewer/Inspector Name -- _ ,1� �{; - - — -- Phone: (4TID) 19 C -
�.
Reviewer/Inspector Signature: Date: s- 17 e
Page 2 of 3 12128104 Continued

I
n
Type of Visit Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: © Departure Time: C] County: 61%&L6h' Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: I Title: Phone No:
Onsite Representative: _m 0ft&_ s Q L_=11 sb fJ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: ' Latitude: = e = = Longitude: F7° 0 ` =
nt
lillifllill11�--,—C
Design C04urrent
y sl
D sign' Currene
a ion
Wet Poultry
Opacity Popula"tion
Cattle
Capac�rty Popat on
❑ Wean to Finish
❑ La er
❑ Dairy Cow
�] Wean to Feeder
n-La er
❑ Dairy Calf
© Feeder to Finish
a
❑ Dairy I-leif6
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cow
6.
❑ Turkeys
Othcr
❑ Turkey Poults
' m
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
(rNNo
❑ 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
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
[❑
Zo
❑ 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?
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 I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: (}*s(-_wn! 3
Spillway?:
Designed Freeboard (in): on,d
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
B<o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr gt, 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 2f/0
ElNA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Siudge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
,1.� 12. Crop type(s) H S 6U
13. Soil type(s) S +
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 01 ❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes E' No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
r/N
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
❑ NA
❑ NE
rqo„r,. U-a ; cs e gy p ,
U Tr,
Reviewer/Inspector Name ^" c: 4j ,;r : LL W: ;1 s;, 'A„ Phone: /% 3 IS = 390 6
Reviewer/Inspector Signature: Date: a
12128104 Continued

r
Facility Number: � — Date of Inspection t Z oS
* Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rain Inspections ❑ Weather Code
❑ Yes Lf No ❑ NA ❑ NE
❑ Yes El"No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ;7No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No d ❑ NE
25. Did the facility tail to conduct a sludge survey as required by the permit? ❑ Yes VNo
VN El NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ N ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElYes ❑ No NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N
[I NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
L—I 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
la o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
_..,,.,//
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2 N
El NA
[-INE
33.
Does facility require a follow-up visit by same agency?
El Yes
Li�Z
❑ NA
❑ NE
Additional Comments and/or Drawings:.
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit fa Routine Q Complaint p Follow up Q Emergency Notification p Other
Facility Number Date of Visit:
Permitted [Certified 0 Conditionally Certified 0 Registered
Farm Name; /......661!�......&M.........................................................
Owner Name: PAC,7. SDn}
...................................................................................................................
MailingAddress: .....................................................................................................................
Time:
❑ Denied Access
10 Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: ..
County:......Qi...GOLcJ.........................
Phone No:
FacilityContact: .............................................................................. Tide: ................................................................
.PPhone No:...................................................
Onsite Representative: ......A.L.) ?........................................................................... .......................... .+/5^I..............
Certified Operator:
Location of .Farm:
Operator Certification Number: ..........................................
J6Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �' �" Longitude �• �' �'
III i P - r t
r, Design '));Current
i I F .t it E ! ' 3 ;j _.f `r - -
9t i,#f#. ;r ; ;Design f�rlCui'rent i,)' ; Pu i# s''= + P I `,i I Design, t,- Current;;,
Swine P r `,
Po"Matron Pt ;'Poultry :' X r Ca'aci P,o i attcsn= ' Cattleli ,1' ::aCa' aci 'Po illation `F
.i:Ca'aci
„
.# R
P' , ❑ Wean to Feeder
' ❑ Layer j ❑Dairy '3
Feeder to Finish
yLy#i; ❑ Non -Layer '; ❑Non -Dairy
❑ Farrow to Wean
d&d iP '.:€...P : ,P,.; �dl
❑ Farrow to Feeder
f ❑Other
❑ Farrow to Finish
f
, � ,)E
ti P Total Design'Ca_padty
El Gilts
Gilt$';E
,� , #�P
❑ Boars
x i`aelq i Fai r��'r �ETota�.LW 1 4! i"
yt G
. n
.,r��.l-
Discharges & Stream lmpacts
1. Is any discharge observed from any part of the operation?
Q Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gai/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 ;2'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes oNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 010
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ...................................................................... ... ................................ ................................... ......................................................................
Freeboard (inches):
12112103 Continued

Facilityumber: &7--04 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
�No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
0 No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
O No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
V1 No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
ONo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground Copper and/or inc
�f}� 12. Crop type 6LVA_t%5"6 ;
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
,� No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes X
No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ANo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 9No
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 )ZNo
Air Quality representative immediately.
Tse€drawtngs'offacility to;better explarn'sitnabons:;,{use brlditannal,pages!as�necessary) �, ❑Field Copy ❑Final Notes silk' (UsIR
3i'.ie 3� € �i;.i. (I, ; '?;`a�9 E �` i ,e;.:c j !t H- i,;` ° i. ,�:c� . i . �3,ii� .`§° o.ii i., i i rr i;I <<':�s° f, • a"°-•,�E€..,k p"rfd. ; o y i i F�� �.r..r SDI i tj F
a7:
3.r:bl. .•n�{ ! rs..'� .s i �. i! Ci-A.;r.ar. Y..a.
2r� A 0 ZP I-OeAr6 6egjZe rr GoC f1.Io �� ERMr'r�i9N,4 �,y� •
W2Tff leeCrXZOS.
15)e,aza'3 ej7;14,,_Z^e,,e
IV
Reviewer/Inspector Name i
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? OYes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes INo
❑ 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
&o
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
0No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(iel discharge, freeboard problems, over application)
ONO
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RI No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
E2rNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
J9No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
ONO
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 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit A Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number 0'7 Date of visit: ! 30 a3 Time: J d 03
Not Operational 0 Below Threshold
0 Permitted 0 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: j3, ", 1-4, t^ rQ _ County: Q'ns
Owner Name: pol er'l' .S Phone No:
Mailing Address:
Facility Contact: Title: 1�► Phone No:
Onsite Representative: d �✓, S �r �'n SU ") Integrator: f U'-l_6h
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude o " Longitude ' 6 «
Design
Current Design , Current -
,,Design Current
Swine Capacity
Population Poultry CaDacitv. Po ulation;.; ,,;.Cattle
Capacity Population
❑ Wean to Feeder
10 Layer I I . ❑ Dai
❑ Feeder to Finish
ID Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
- -- ....
❑ Farrow to Feeder
❑Other i
❑ Farrow to Finish
Total Design Capacity
❑ Giits
❑ Boars
Total SSLW
" Number of La&ns -,v%-
❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
Hold€n ir, nds / Solid Tra s
g, p
❑ No Waste Mana ement
+.Liquid=
�
_
��..,
�f_ ; �
-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo
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 0-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:]Yes J:'No
Waste Coliggitillp & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 10'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 35
05103101 Continued

Facility Number: 617 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Wa to Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Croptype %SLT•`^vG[�i -igvl. S►"�""+ri _�'y/� �j alle" O'd
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?
Regpiped Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes �No
❑ Yes ONo
❑ Yes XNo
❑ Yes gNo
❑ Yes /P'No
❑ Yes )D No
❑ Yes �INo
❑ Yes ONo
❑ Yes 0No
❑ Yes �3'No
❑ Yes PNo
❑ Yes ONO
❑ Yes ONO
❑ Yes 0No
❑ Yes JNo
❑ Yes ,?l No
❑ Yes ONO
❑ Yes ONO
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes ONO
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comirnents�(refer+to:question #) xplain anyNES,,answers�andlor•any�rccam en atians or auy others blfi tents
Ilse deawings'bfxfacilityuto betteir ei�plaii situations ,,(use,additional°pages as.necessa,Q) q. ❑ Field Copy ❑ Final Notes
X f� Aa
� � ''1�'�""' .".-�F .tu .its. . .r 3. .:.{�'. i:s. w •. ... �i. �$J.'.'CN .in,.�.x�9�+!E
well wew►�%..�c;����. rh�. i��j��•� is wrIr fCc/'-;t
I
AL
o,utel �,►�' st,,,,nt hF�`-•S� are 'r ,'.; t,�Eil rn�+'�c The �e:�„✓tUct�;
.x�;�-•«,+l �r�,�'^ c r ��s ra�� will �.S�y 6I:s1-,��, nl�.c� +�� : e��.�.5 try
� �c;� ��::.:Y. cen S4 mac: ��c,4 n=j Li �e,
ems, �1 y. '- �• A -te,-L'"AL-
L-
1r
T� '� ✓ C1 1 h Sv +�-l'4, c e tom/ � - � �' L ^A 4 t� C�: ->"i V- !Cal, n� / . {J ,'' i✓1.i C:�1 S;{, xl f
-�In,"s ii1 c, w-i`I w�.�,Fs Wrl1 LJc SsCU.:Scz4k �o;� �Zt; r
Reviewer/Inspector Name I e' ." 4Z. ..vv *k)
Reviewer/InspectorSignature: - Date: 1 3663
05103101 Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes o
❑ Yes "No
❑ Yes No
❑ Yes J'No
❑ Yes R/ No
❑ Yes ❑ No
Additional Comments and/or Drawln s •. ' ,
AL
i �? G '� �� a vt IC N G �t T c"� �C, /c :. , ct !i G �1; a "� ®✓� (, cy Yi S7+' c/ ! •«�
.l
��.r e �,.i M � � � wry � C, v► G� ~�©'�! G3 %r � O''t-'� G-��'oJ�J -f a �,nC.� � +� � ct �' `"� ��} E'
05103101

s •-
Type of Visit ZFCompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit -(2lRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I
Date of Visit:
O Permitted O Certified D Conditionally Certified 0 Registered
Farm Name: Mo>e ,'`T Br/�''tSor'` F`ar✓,
Owner Name: m O r f'` J !.� ►^ i ^SO i,
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Time: 110 1
rO Nat U me rational 0 Below Threshold
Date Last Operated or Above Threshold:
County-.0 P? S% o t'✓
Phone No:
Phone No:
Integrator: JeV
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0a 66 Longitude 0' 04 �u
Wean to Feeder I OIL] Layer I U D
Feeder to Finish 2-4 g i Za Z ❑ Non -La er ❑ N
Farrow to Wen ,1w.
Farrow to Feeder ❑Other
Gilts
Subsurface Drains Present
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gat/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?
Area IL15
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:
❑ Yes ,2�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ffNo
❑ Yes ❑ No
❑ Yes 'ONO
Structure 6
Freeboard (inches):
05103101 Continued

s
Facility Number: &7 _9L4Date of Inspection 2 Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes eZ'�No
❑ Yes dNo
❑ Yes iCJ No
❑ Yes ,!fNo
❑ Yes eNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2f No
11. Is there evidence of over application?j j ❑ Excessive PPonding ❑ PAN ❑ Hydraulic Overload ❑ Yes ,�No
12. Crop type d e r �+~` p( ®1 �h! L y , 5-r-L^ r ca i h _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ZNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes JZ'No
b) Does the facility need a wettable acre determination? ❑ Yes ZNo
c) This facility is pended for a wettable acre determination? ❑ Yes O'No
15. Does the receiving crop need improvement? AYes ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes L�rNo
Reaulred
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes _0"No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes,-6No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes ❑ o
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes JZ No
2t.
Did the facility fail to have a actively certified operator in charge?
❑ Yes )ZNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes � o
(ie/ discharge, freeboard problems, over application)
/
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El yes � No
24.
Does facility require a follow-up visit by same agency?
❑ Yes.'ONo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
0Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
#) Explam'any YESxanswers and/or any recommendations orouany other comments.
Comment's (t efer`tarques�be
Use drawings of facility, er explain situations (use ad ditianahpages as necessaeld Copy ❑Final
s_ Fi Notes,
11. AJ e.CA t-a W f ? `f Q 4 � e O 41,,c !%P. es6,o,' -P( r'e6orplx� I�p ter �I?izC�
�ve '
A nd �-�� �(�p��-, q.,a,'I c �r ; ►•,.r�6 c-�►o,•,. 1Uee� f o �e sure -� a
6l e .�
e wo,s4r_ .stf 4q4 d ►-o 2-on (D of ,,yJ
; -r n-e 1'yS)'�S -�a � � eove�L,G' 6 t4 pt e r Z991
O s r r1 9 tea, A r.so> t o �50ee 4o v.se Ayi Al \ j f t1 ;44; K bB A y s
aF eveA -�s Wa G Ct 1 c tJ o►-e AC Al 4t,a
Reviewer/Inspector Namee>
ReviewerlInspector Signature:L = Date: .� Q
05103101 Continued

a
Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes �No
❑ Yes 10 No
❑ Yes )ZNo
❑ Yes 2rNo
[--]Yes ZNo
❑ Yes ❑ No
AdditionaLCommeuts apolor Drawings ?; .;` ,
15. `rk e re Azle !ow a reau. i n -eke F1 e (o{
ter, to11 (1f -f � P. ���vj0� nrt �'�a �7 S0`nde (IjL` e-1�
s Pr� 0,5 �- � r �, 4 c� -� o In E �i old -/ kasc o ec A,s q p1,�
9 /
�v Gold �,., °1 a''4 4-ke Crer' �F 6c'-eKuda is no) jOyae� 4;1'e .
inl a / k n cc l
in o 1,4 r'� we.'ke' 4))1�
Z5. OP, yge,d some :epv1es w i'- sr�al! rt/�vtin, ��e G✓��1�
repv,relit` 4.o Je rtq,7- -zW tv,44 �lx^4,g119>rat'J�e,�
! DUee6� 40 1Ceeip f 1-1-EcUL-0q/G( %1-, e--.bll'd f OIn (-I.t1Q--�'� t7GS�S.
05103101

Ib1ViSion Of Water Quality
_
Division of Soil and Water Coiriservat_ion 4
Q Other Agency
IType of Visit )4 Compliance Inspection Q Operation Review O Lagoon Evaluation 1
Reason for Visit Woutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 71�-8 k Time: 0= Primed on: 10/26/2000
Q Not O erational Q Below Threshold
)4Permitted 13 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
FarinName: ..... &.'..:.��.... �'.1' 1F4.................. ....... .......1.1.......1.1,.......... ....... County: ... OV .. S .W....................... ..........................
OwnerName: ................................................... ........................................................................ Phone No:
Facility Contact:....l'itle:................................................................ Phone No: ...................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative: ,QW "� Integrator:..... . , f.. ..._.
.......... ............................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
rw
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude " 6 �& Longitude • Imo` 44
Design Current Design Current Design Current
Swine Capacity Population Poultry _ Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
%Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. II'discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. II' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes b�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [ rNo
❑ Yes. ONo
❑ Yes XNo
Structure 6
ldentificr:........................................................................................................................................... ..............
Freeboard (inwhcs): -b
5/00
Continued on back

Facility Number: : Date of Inspection I printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees; severe erosion, [j Yes kNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes kNo
(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 Ar,_alication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Sig 4 Gw�-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �VQ yi�laiignjs oi" . cjenpip5 •rare )i e(j. during 4his;visit; • Y;oii Wiii•reeoiye ;tio WOO
cor'resb&ideitce:about:this visit. ..::. •... •- •..... •. •. •. •.•. •.•. •. •. %•. •.:::::::: :
❑ Yes k'No
❑ Yes No
❑ Yes V No
❑ Yes 4 No
❑ Yes O(No
❑ Yes 0 No
64
❑ Yes K No
❑ Yes j� No
❑ Yes No
❑ Yes No
❑ Yes W No
[:]Yes N No
❑ Yes WNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
p Y. Y
Comments -(refer to question #): Explain an YES answers and/or an recommendations or. any other comments
Use drawings of facility to better explain situations. (use additional' pages as necessairy)
Q { �
Reviewer/Inspector Name
Reviewer/] nspecto r Signature:
i-
Date: `Q L.... 5/00

XDivision of Water Quality
Q Division of Soil and Water Conservation
O :Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other r-�❑ Denied Access
Facility Number
t)ale of Visit: TiTime.j� L.�S_.?�J Printed on: 7/21/2000
0 Not Operational G Below Threshold
[] Permitted (3 Certified
1 13 [Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
1 r�G V' 1k6....1�.. `"� �'�...... ... County:...................................................... ........................
Farm Name: ...... ...........ti..:...... .... ...........................................................
.......................
OwnerName............................................................................................... Phone No:.......................................................................................
Facility Contact:...............................................................................Fitle:................................................................ Phone No:
...................................................
MailingAddress: .......................................................................................................................................................................................................... ..........................
t _,
Onsite ltepresentative:... �""`�{.Y.............................................................. lntcgrltor:......�..........%..............
.......
.......................... ................................. .. :
Certified Operator:................................................................................................................ Operator Certification Number...........................................
Location of Farm:
[]Swine []Poultry []Cattle []Horse Latitude ' 4 '1 Longitude ' 4 C]«
Design
Current Design Current Design Current
Swine Capacity
Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
JE1 Layer ❑ Dairy
Feeder to Finish
❑ Non -Layer JE3 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 ❑ Lawn Area 10,Spray Field Area
Holding Ponds / Solid Traps
❑ No Liquid Waste Management System
Discharges & Stream Im�tti
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. Ifdischarge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/tnin?
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 Structurc 2 Structure 3 Structure 4 Structure 5
Identifier: .................................... .................................... .....................
Freeboard (inches);
5100
❑ Yes MNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KNo
❑ Yes 0 No
❑ Yes XNo
Structure G
Continued on back

Facility Number: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes gNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes j�rNo
(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
b�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
D�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
IYNo
Waste Application
10, Are there any buffers that need maintenancelimprovement'?
❑ Yes
�(No
1 I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
ZNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
.bRrNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
RfNo
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
ZNo
16. Is there a lack of adequate waste application equipment'?
❑ Yes
KNo
R_eauired Records & DocumcnLh
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
)�,No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
Nf No
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement'? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
[Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
h�No
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes 9No
24. Does facility require a follow-up visit by same agency'? ❑ Yes No
25. Were any additional problems noted which cause noncompliance'of the Certified AWMP? ❑ Yes ftNo
d0flcieudes not;ed•during this:visit:• Vojt WiII•teeoiye o fui-thg
correspondence. about this visit.. . • . . . . . . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): v-� L.c -0 CL__r is Q (/4e - #
Q `� -J�1A.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5/00

1Facetity Number: Dale of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below kYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes J�JNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [YNo
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 �Wo
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 VRWo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [34go
al

t'Wr
10 Routine 0 Com faint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review $ Other
Facility Number Date of Inspection 2 !X1
Time of Inspection 1 1515 124 hr. (hh:mm)
0 Permitted © Certified r] Conditionally Certified 13 Registered JE3 Not O erateonal/� Date Last Operated:
Farm Name: t.... 4 -- i r 5 r i o r"C1 i' County:.....5�......,f�fl.......................................................
........................................................................................ l'� W
OwnerName:.............. % ✓....s............ y.r"�xaI.......................................... Phone No:.......................................................................................
FacilityContact:...:.......................................................................... Title: .............................. I ............... Phone No:
MailingAddress:......................................................................................................................................................................................................... ..........................
OnsiteRe resentative............................................................................. Integrator:.....�t.`�`'`s.. p ..........I..........
CertifiedOperator: ................................................. ............................................................. Operator Certification Number:..........................................
Location of Farm:
i
... ... ..................................... ....� ..
Latitude =• =1 =11 Longitude =• 0' ="
! „..
Curr_e z
nt
�!;1?o
Design i
- ' ' r
t" rsCattle get 'i `� r Design
Swt Ca 'acgi tion
PCprrent
Point ry Ca ulatton' i .;Current
E ula
. act o „F �s.: ..i„ Ca act r ;�Po ulation .,
❑ Layer ; ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
;�.
^`a. _ .., .. r �.. „r, s ,., .�.'_.,:, r ,:, ,. �•� ,:. f_..7.j :: °t ° r 1 r G:"fir
❑ Other `
Rgi
Total Design Ca�act{ty;,
�Totat SSL' W'` ;
' Number ofrLagoons
f' Subsurface Drains Present ❑ La oon Area S ra Field Area
❑ g ❑ p y
Holding Ponds I Solid Traps a: ❑ No Liquid Waste Management System
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Boars
Discharges & Stream ImRacts
I. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes ❑ No
b. If' discharge is observed, did it reach Water of the State'? (If` yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..................................................
5. Are there any immediate'threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

i' Faculty Number: (27 —8 t Date of Inspection 2Z
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑'Yes
❑ No
Waste Apoliottion
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12, Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc,)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Rcviewer/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
fo yiolatitjris:or d�iFieiencies i�gre pgfed- during this'vlsit; • Y;oir :will-ceet<iye Rio IF�t>�tl�Qr.
corms onc�eizce: abfluf t#zis visit.
C64iments-(refer to. quesiiom#):,,Explatn_any1,YES,answers and/or any, recommendattons or any other comments a ft l �r,=,,�
t se'drawtngs of facility to'"hetter ekplatn situatininst (use'addihonal"pages as•neeessary)
7 , f� fC
• L n s�v Q G-�i r' 0•,�1s� o h 5 2 -,Fn G� ✓'e�v r� O-i a v� ► ✓1-t� 1
71 e % etw 1� 1/ P ✓' . d GV i0 e rl &G 0-0�, G./�l S %ef vi,-LI
TG
Reviewer/Inspector Name
Reviewer/inspector Signature. Date: 512 ZIOO
�II►�cICl]

Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number G
p - g Operation is'flagged for a wettable
Farm Name: acre determination due to failure of
On -Site Representative: ' w r Part It eligibility item(s) F9 F2 F3 F4
Inspector/Reviewer's Name:r����
Date of site visit
Date of most recent WUP:
v Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Annual farm PAN deficit: 90 pounds
ligation System(s) - circle #: 1. hard -hose traveler; 2. center -pivot system; 3. linear -move system;
stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
B. stationary gun system wlpermanent pipe; 7. stationary gun system w/portable 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 D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
IJ E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part Ill).
PART 11.75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F1 Lack of acreage which resulted in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of info rmationlmap.
F3 Obvious field limitations (numerous ditches; failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revis-d January 22, 1999
Facility Number -
Part 111. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE OFTOTAL CAWMP FIELD I COMMENTS3
NUMBER NUMBER''2 IRRIGATION ACRES ACRES %
SYSTEM
II r-).6, I I I - - t t-),<p- - 1 II
FIELD NUMBER' - hvdrant. oull. zone. or point numbers may be used in place of field numbers denendino on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBER2 - must be clearly delineated on map.
COMMENTS3 - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

ivision of Soil arid'WatcrConservation - Compliance h
� . D Division of Soil and Water Conservation - Operation 12evi�w
� D p Inspection • _• 3 � F .
r E Division of Water Quality -'Compliance Inspection ,
Other Agency - Operation Review
10 Routine O Complaint O hollow-un of DWO insnection O Follow -Lin of DSWC review O Other
Facility Number Date of inspection 1 111
I'inte of Inspection G 24 hr. (hh:mm)
©Conditionally' g' [3 Not Operational Date Last Operated:
1KYermittcdCertificd Certified ❑lie Registered atecl:
Farm Name: JX\Ch�rl�r�l...'�r County:,.•.0t^Q+................................................. .
Owner Name:.. .............. Phone lN'o:....................................... ................................................
FacilityContact:..............................................................................Title:................................................................ Phone No: ......... ... ............................... I .... ...
tMailingAddress: ....................................................................................
Onsite Representative: Integrator: M�.................
..............................
I.
Certified Operator:................................•............................................................................... Operator Certification Number:..........................................
Location of Farm:
r........................................................................................................................................................................................................................... ..............................�
Latitude Longitude
Swine Capacity Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other I I
Total Design Capacity
Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area JE1 Spray field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Dischar>:es & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)'?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance elan -made?
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. II discharge is observed. what is the estimated flow in gal/mill?
d. Does discharge hypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Structurc I Structure 2
Identifier:
Frceboard (inches): ..... ......—'1..��.............................. .................
❑ Yes N�No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes Itq No
❑ Yes C<No
❑ Yes A No
Structure 3 Structure 4 Structure 5 Structure G
1/6/99 Continued on back

Fa ility Number: 6 — g Date of Inspection
5. Are there any immediate threats to the integrity of any of' the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovemcnt? .
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 top of'dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence fover application? ❑ Prntding ❑Nitrogen
12. Crop type ................... ........,.................,...............................
0
❑ Yes 9No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application cquipmcnt?
Required Records d Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes XNo
❑ Yes Wo
❑ Yes M No
❑ Yes Rlo
❑ Yes E�No
❑ Yes KNo
❑ Yes O No
❑ Yes rVNo
❑ Yes 9No
❑ Yes 9No
❑ Yes �( No
❑ Yes &No
❑ Yes ONo
❑ Yes RNo
❑ Yes M No
❑ Yes N No
23. Did Reviewer/Inspector fail to discuss revicw/inspection with on -site representative? ❑ Yes JgNo
24. Does facility require a follow-up visit by same agency? ❑ Yes INNo
Nu.vio]ations:or• deticienc�es were Hated during thi�:visit:. I'.au vvi�l.reeeive na further
eorrespaidence: about: this visit.. . ............... .. .. .
Comments:(iefei••to question #).',Explain any YES answers and/or any,recommendattons or any other comments I':r' tt 3 ;
Use drawings of facility to better explain situations. (use additional pages as necessary):{ t r ' { C' i; a
W4?_[
L.� � tl ln-,Q• t'�y4 i��z� � j 1� �� � ,Q 'I�� IGC. 11R�t.v � , G� s�S ,�v� �
°�t�r�9�� ���s��� L;si ,,,� �,�.Y •���� .'C �.-aye. �eq�-.Q,�c�
`
SCOo
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: (113
1 /6/99

J13 of Soil and Water Conservation 0 Other Agency
.11,1ffivisionjMDivision of Water Quality A
Routine 0 Coni' laint O Follow-u of l)W ins ection O l:o€low-u of 1)SWC re►-iew• O Other
Date of lnspection /G
Facility Number �—�-- ��,
Time of Inspection L� 24 hr. (hh:mm)
E3 Registered t('Certifed Applied for Permit [3 Permitted © Not O eratir►nal . Date Last Operated:
Farm Name: E qZA., .�.N .. !Cae.44.... .......... ... County: ...... Q 64:SK �ItA%,..............................................
Owner Name:...../UiO�......a/�INSQ�I �...... Phone No:......................................................... `ll Jam% ,l..........................
..... ......................... ....
Facility Contact:......r..........d/)FSD............. Title: ... tIpGUJviti, .... Phone No:
1. Mailing Address: 4 , �, .. �. '�' ....2. ..... (�..lG/�G/;N .:S .... C :.................` �,,`_.7. .... ..........................
OnsiteRep resentative:..Pv2g LA.........15gl..N.. 4 Integrator: ...................................
Certified Operator.,.......1.1!_02A � �121N„S .. Operator Certification Number;......................................... ''�
........ ........... ..... ..........................................
Location of Farm:
'..................................... ....../ ....at l................................................I................................................................... o F...... .F........z-1 .........`=`........... ....... ea ...............................................
Latitude ' =1 ° 3s " Longitude 77 • =° ="
Swine `
Design.:4� ' Current Design Current Design Current
Capacity Population Poultiy Capacity Population Cattle j' Capacity_•Pnpulation
❑ Wean to Feeder
Feeder to Finish'
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑Dairy
❑ Non -Layer ❑Non-C
❑ Other '
Total Design Capaci
Y 3 Total SSL'
Number of Lagoons 1 Holding Ponds j r Q Subsurface Drains Present 10 Lagoon Area 10 Spray Field Area I ",
'y. ❑ No Liquid Waste Management System
s>r,,.x
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes krNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes Wo
maintenance/improvement?
b. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes gNo
7. Did the facility fait to have a certified operator in responsible charge? ❑ Yes �No
7/25/97 Continued on back

��
Facility Number:--61j — Bfk
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lavoons,lloldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes V No
ElYes lb� No
Structure .5 Structure 6
Identifier:
Freeboard (ft):..........`7..t.9............... .
10, Is seepage observed from any of the structures? ❑ Yes ] No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes No
12.
Do any of the structures need maintenance/improvement'?
❑ Yes
k No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimurn or maximum liquid level markers?
❑ Yes
lkfNo
WasteApplication
14. Is there physical evidence of over application?
❑ Yes
�No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15,
Crop type COBS%A�... .fir !!'%uD......le�lt�............. I—.................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
4 Yes
El No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes D No
18. Does the receiving crop need improvement? ❑ Yes (VNo
19, Is there a lack of available waste application equipment? ❑ Yes [�_N0
20. Does facility require a follow-up visit by same agency? ❑ Yes k No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ['o
22. Does record keeping need improvement? ❑ Yes LfkNo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes .� No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP ❑ Yes IQ No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes kNo
0 No.violations order cieneie's.were noted during this:visit.- :You.wiil receive no further
correspondence &oitt this visit'., .:
Cormnents (i44!to question#): Explain any YES answers and/or any recommendattons;orany other comments
Us ,drawings af`faciHiv to better explain situations; {use additit�n rl a es'as necessary): `
K
r
eLv— - n�c-e-�Q �2e Sint e_ Lv u P i✓n - �o—�
PA,tJ P"APAC:r_� ,
7/25/97
Reviewer/Inspector Dame
Reviewer/Inspector Signature: ` Date: /d 9

4 w
°{ ❑ DSWC Animal Feedlot Operation ReviewYrv��`Ms
,12DWQ Animal Feedlot Operation Site Inspection
WA:-
10
Routine 0 Gon) Taint 0 Follow-up of MVQ inspection 0 Follow -tip of DS%VC review 0 Other
Date of Inspect ion
2 y
Facility Number �
Time of Inspection LLB 24 hr. (hh:mm)
© Registered INCertified © Applied for Permit © Permitted JE3NotOperational I Date Last Operated:
FarmName:. ..................IM-1-................................... County :......... .�1�.�.41��....................................
Owner Name :..... f'" ` :'............. ...................../+% c Ft..�. I'hctnc 1 a: .....................................
>e4 .........3.7..
Facility Contact:..M.Qzlk.oc................................................ Title:. .. Phone No:
Mailing Address ....... .a`+, 3......t .......%J .,l(1 ..... .art..{.(�4c4 �..................................... Z
�7 ........................ .... '
Onsite Representative:..1!i-.U...!r.4.. ....................1.c7.V� �/1�.� �7,�1........... Integrator: ...
....
.......
.............................
............
Certified Operator, .............. C .S. i'"]................... Operator Certification Number:......,................. ..
Location of Farm.
....................................................................................................................................................................
A
.................p..-Qk.....................'........,(1.5°7.... ...............
C......................z.`...................................................... .
Latitude • 1 �" Longitude =' '="
twine
❑ Wean to Feeder
JZ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Population
Design- Current Design Current`x
Poultry Capacity Population Cattle Capacity Population
❑ Layer 10 Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other 1 1
Total Design Capacity
Total SSLW 1 330 1HO
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑Lagoon Area 1E1 Spray Field Area
2,? fr, 10 No liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
GLNo
2. Is any discharge observed from any part of the operation'?
❑ Yes
0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-Inade?
❑ Yes
P] No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
❑ Yes
13 No
c. If discharge is observed, what is the estimated floe' in k*alhiiin?
cl. Does discharge bypass a lagoon system? Of yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
gjNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
Q No
5. Does any part of the waste management systen) (other than lagoons/holding ponds) require
❑ Yes
O No
t maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J9 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
MNo
7/25/97
Continued on back
w -1

's
Facility Number: &I —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.tiolding Ponds,_ Flush. Pits,. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ......... �1/.... {R.........................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes ANo
❑ Yes 91 No
Structure 5 Structure 6
....................................................................
❑ Yes allo
15. Crop type ....................G`i�...............................................�'-Cr................... .............................. ...............................
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?
2l. 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.vitilations-or deficiencies. were• Hated -during this, visit.Aodw'ill receive• noftirther.
correspotadepce. about this'. visit'.,',
❑ Yes [3NO
9Yes ❑ No
❑ Yes MNo
❑ Yes Z No
❑ Yes 0 No
❑ Yes ® No
❑ Yes O No
❑ Yes XfNo
❑ Yes l,No
❑ Yes 10 No
❑ Yes AX[No
❑ Yes 4 No
❑ Yes Q No
❑ Yes Q No
Za ter✓ �•v�s A,yr��� �/���.v Se,���.�, rh,Q f�,.� sue-,,��.
�� tj'+v� � � rx�[- � !✓T��"'c,� �i/. 4�/I/�.. g�t��--5+� lv{l� 0��—
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: