310005_INSPECTIONS_20171231

NORTH CAROL#NA
Department of Environmental Qual

"> (ORDrv�siontof Water Resources
����01
Facility Number I J {:J ;© -;� O Dtv�s�on ofSo 1 a d'Water Conservation'
# ti
Type of Visit: Co fiance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ir> County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: MOP S Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
r _
Design Current es Cnrrent
Design Current
in Ca air Po WetaPo 1 Ca ci Po
P ty p tT3_ p lY p
Cattle Ga aci Po`
..
Dairy Cow
Wean to Finish
ILayer
I
Non -Layer
I
Dairy Calf
Wean to Feeder
Feeder to Finish,
Dairy Heifer
Farrow to Wean
D sign Current
Dry Cow
Farrow to Feeder
. -]D PouI Ca as P,o
Non-Dai
Farrow to Finish
T7
Layers
Beef Stocker
P Gilts
a-' Non -La yers
Beef Feeder
Boars
,..
Pullets
Beef Brood Cow
Turkeys
- -
Qther
Turkey Poults
, Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 �r ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes EJ'No ❑ NA ❑ NE
❑ Yes �No❑ NA ❑ NE
Page 1 of 3 21412015 Condnued

Facility Number: jDate 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9- �t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes rNo ❑ 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 reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 CfNo 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
KI [DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes❑
NA
FNo
❑ 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?
0 Yes
E21N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E7K❑ 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 EXN. ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No [DNA ❑ 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 ICJ 1`o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E 1" o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 [:]No ENA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
[] Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes C rNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
NA ❑ NE
g�No�C3 NA ❑ NE
Reviewer/Inspector Signature: ��.i�/ ' Date: TArLo
Page 3 of 3 21412015

ivisiod of Water Resources
Facility Number ©- ® 0 Division of Soil, Water<Conservation
0 Other Agency
I'ype,of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral emergency 0 Other 0 Denied Access
Date of Visit: I 3 u y Arrival Time: rp;I Departure Time: .' County: Region: w
Farm Name: (' nFctr1/l/l [ — Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: jrn J
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Designs "Current'"Design,Current J Design Current
Swine Capacity hPoP- Wet'Poul try �_ Capaci#y .-Pap. Cattle= _.....Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Design,'_ Current`
Drv-Poultry ;A�.Canacitvy � -Pon:- -
Layers
Non -Layers
Pullets
Turkeys
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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0 Yes
anwto )Ayei%l�
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[E:r No
r] NA
❑ NE
Q' Yes ❑ No
❑ Yes ,0 No
[:]Yes C.-
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: - Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes Q4No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3 ( 3 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Fe.,'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
,❑'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J2 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
19Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
k] No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
f J NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
Ej NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] No
❑ NA
ONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropriate box.
jo
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA f2 NE
❑ Weather Code
❑ Sludge Survey
❑ NA ONE
❑ NA ffNE
Page 2 of 3 21412014 Continued

J
Facility Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ',Q-NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA ❑'NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA .❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA l:. NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑"No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ZNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA ONE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes [:]No
❑ NA ONE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 2] No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes '0 No
❑ NA ❑ NE
Comments refer to ues ##):. p y YES, an ail addition s,or a other comments.-
( q tion Explain an ditionalFrecommendation ny-
Use drawings of facility to better explain situations (use additional a es:as necessary);
RedeuC) a CQ H -666IN Mickae4 N&A5 e6h(ernj n_ 5P11 E 414
0CCU(['eeP Qr I/2z
iscla f lao vo ve, a ared
pipe t- was (1(3-kced 4')�a�
0%kf p" Q COL-)rN
n �Pe_ c6sed bq4- upyi dtLe3; !" 4p
4-,-c u atu e -(�, lLej j C[S, c:, lV + ,,
+ T1� Poor eta-1k' oe_"� t 56t G�� (,� Vo) VC ct 110,0,od az,4-- 4e J-favvlf � o �.
od . Tyt- oI'�sstC l � b�PGv
� �� 4P P
lk- W [ kVX1 v. --, y1.o C _ T--- is es- i r LMW (9r 000
L�allov[ S t,, S a,s ckQtgrd f ►o-o o1 -Fletd t,�[�c�rtiv5. -1-4-- cAQ-5 4;c-54-4` W
5 Ca4 t® yl°WP +ccc feted jo bcovel eid iac�- l w t 4^ 4urArl- l
4 T
e la u-S +a P6 a .�e.�-�- — s no LA0.5�e wm s coo S e CU.0j I emo 1 " -Ct� ct(j(n,c8
NOV Wick b-e 15S(APe 9. DwP {e (_0MtN^s �.
Reviewer/Inspector Name: vV1 Phone:
Reviewer/Inspector Signature: Date:
(193 /ZY—
Page 3 of 3 21412 14

—*Division of Water Quality,..
F-Acility Number 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit')Q'110"utine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
c
Date of Visit: % Arrival Time: +' Departure Time: County: Region:(Al I
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: &Icas
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current:
Swine Capacity, Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑Other
Phone No:
Integrator:.. /os
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c = d = « Longitude: = ° 0 ` = «
� .. 1,
Design 'Current,, -,Design Currenf
Wet Poultry Capacity Population Cattle w Capacity1'opulah©n.
❑ Layer
❑ Non -Layer
Dry -"Poultry . .-
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures;, -
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes JQ'No ❑ NA ❑ NE
❑ Yes )
❑ NA
❑ NE
El Yes No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes No
❑ Yes �eNo
❑ NA
❑ NE
❑ Yes )2No
❑ NA
❑ NE
i
Page 1 of 3 12128104 Continued

Facility Number: 71- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes o
❑ 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 XNo
❑ 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 ZNo.
❑ NA
❑ WE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 7No
❑ 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 PNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes J No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �' o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0'&o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes )�fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes )D'No
❑ 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 /VrNo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ff 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 j2rNo ❑ 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 4o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
.24. Did the facility fail to calibrate waste application equipment as required by the perm . ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 25'N o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes J2 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes O—No ❑ NA ❑ NE
❑ Yes JET�No ❑ NA ❑ NE
❑ Yes 1�]rNo ❑ NA ❑ NE
❑ Yes ;?r-No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,2j'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Ea`No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [2r�lO ❑ 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 awes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: J
214 011

vision of Water Quality
Fazility Number i O Division of Soiil and Water Conservation,.,:
O.Other. Agency
Type of V➢sit eo CoCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: C G T Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: /� Title:
Onsite Representative: �(— 1'G C_9;7jr�_
C
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Region: 6�
Latitude: [= o[= 1 0ds Longitude: = o= 4
:'Design Current Design C Current
g g Curren ' Des!gn
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity, Population]
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean Dry Poultry,_
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other....
❑ Other �A
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures
a
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
�I
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
E/No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes /� No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3�—W,
07 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 1 Structure 2 Structure ? Structure 4
Identifier: �J
Structure
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �2No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes Pi No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes /No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes /No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside -of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question ii): '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):
AL
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
1212810 Continued

Facility Number: —cy Date of Inspection es /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [:?'No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Xlo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
21 No
❑ NA
❑ NE
❑ Yes
[No
❑ NA
❑ NE
❑ Yes
[J/No
❑ NA
❑ NE
❑ Yes
['lo
❑ NA
❑ NE
❑ Yes
E
❑ NA
❑ NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
[?(No
❑ NA
❑ NE
❑ Yes
[�'No
❑ NA
❑ NE
❑ Yes [, No ❑ NA ❑ NE
❑ Yes
IVNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
Page 3 of 3 12128104

'Division of Water Quality w
Facility Number J �a Q Division of Soil and Water Conservation
Other Agency
Type of Visit OJ;dfiltpllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (�rftutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: eparture Time: County: Region:
/
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
Integrator• L
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = g = Longitude: [= ° =1 =
Design Current Design, Current Design ''Current";
Swine Capacity Population Wet Poultry Capac.typ Population Cattle Capaci"ty Populahon
4,. �—
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La yer
❑ Non -Layer
Dry.Poultry .
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
hi6mb0r of Stru' ctures
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes WNo
❑ Yes YJ No
❑ NA
❑ NE
❑ Yes /No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other .
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain
Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
/No
❑ NA
❑ WE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
7No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[(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
ElYeso
VN
❑ 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
VNo
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
VN o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number: 3Z— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes S2No ❑ NA ❑ NE
Stru re I Struct 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: AM
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ o ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes O No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Oo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑Yes No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [XTo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift' ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2rro
❑ NA
❑ NE
I.IJ
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
No
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,JQ N
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
i 'Yc
❑ NA
❑ NE
Conninents (refer to question #): Explain anv YES ansRers and/or any recommendations or any othe comments
Use.,drawings offacility to:be#tergexplain situat►ons (use;addition, pages asnecessar 4.
G S
L/
Reviewer/Inspector Name: a ti w Phone:
Reviewer/Inspector Signature: Date: /
Page 2 of 3 12128104 Continued

0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- 0 Other Agency
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 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:
Time:
Time: County:
Owner Email:
Phone:
Facility Contact: Title: �Phhone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Region:
Latitude: = o = , = Longitude: = ° 0 , 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heife3
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ElNE
❑ Yes tNo
o ❑ NA ❑ NE
ElYes ❑ NA ❑ NE
❑ Yes No ElNA ❑ NE
❑ Yes N ❑ NA El NE
El Yes (((� ❑ NA ❑ NE
12128104 Continued

Facility Number:% Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ,,Z'No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes LdNO ❑ NA ❑ NE
Struct e I Strut 2 Structure 3 Structure 4
Identifier:
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 L2<0 ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �'1 To ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ; No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes X 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 'KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes P<o ❑ NA ❑ NE
maintenance/improvement? ,.,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes l J401 ❑ NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload ❑ Frozen Ground El 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
1j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑X
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[PKo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L�qo
❑ NA
❑ NE
Reviewer/Inspector Name Phone:
100
Reviewer/Inspector Signature: Date: =:� .2rf ~ G
Page 2 of 3 1212810 Continued

Facility Number:Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No El ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes tNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design(((((( El El
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
/❑
❑ Yes ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [�4
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes Z No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes l "'
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT") certification?
❑ Yes "CJ IVo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes j2No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
Elo
❑ 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
t_J'tvo
❑ 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
,,--,,!!
ld�to
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑'1 ]�o❑
NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
D �❑ NA
❑ NE
Page 3 of 3 12128104

,w Division of Water Quality
Facility Number 3 l Gt'/ Q Division of Soil and Water Conservation
- Q Other Agency
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: L {C>,
Farm Name: �__%
Owner Name: —
Mailing Address:
Physical Address:
'Arrival Time: eparture Time: County: Region: �, �/
!�6� r ��— Owner Email:
Facility Contact: �J Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No•
Integrator:
T
Operator Certification Number:
Back-up Certification Number:
Latitude: = o=' Longitude: 0 0 0 r
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I I' JE1 Non-Layet
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes _No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
KNa
❑ NA
❑ NE
12128104 Continued

Facility Number: 3= Date of Inspection E067
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struct e 1 Structure 2 St ture 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 [;3'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 9,No ❑ NA ❑ NE
through a waste management or closure plan? /
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes UNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
?No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes
no ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
YNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
o ElNA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
PrNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
o ❑ NA ElNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
wo ❑ 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):
r/V7
GLrl_;5hr !�/ r
Reviewer/inspector Name V14T GCcJ Phone: -�
Reviewer/Inspector Signature: Date: gg
12128104 OF
Continued

Facility Number: f — (j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[J`No
❑ NA
❑ NE
23.
If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z` o
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[-No
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,.//❑_,/No
t d No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E'YN o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑�+lo
El NA
El NE
and report the mortality rates that were higher than normal?
//
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑.No
❑ NA
El NE
If yes, contact a regional Air Quality representative immediately
//
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E�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
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[/To
❑ NA
❑ NE
Additional Comments and/or
12128104

Facility Number 3 ��
Q Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit compliance 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: n Arrival Time: ,.':�7 3 C Departure Time: County: Region: 1-✓/�
Farm Name: ) %0 /L�l� i� / — Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: G'
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator• A4'.06i1__a —
Operator Certification Number:
Back-up Certification Number:
Latitude: [= e = Longitude: = o =1 ❑ fl
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish
/,2�7O
4(i0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Layers
Non -Layers
ers
Pullets
Turkeys
_Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
.Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of Inspection
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ?
Observed Freeboard (in): 060(�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE-
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name r ��d!`L f�h� — —] Phone: Ql�% 7�� �.•7��
P
ReviiewerlInspector Signature: Date:
Page 2 of 3
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12129104

Type of Visit ,otompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vis`it4olkuutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County. Region:
Farm Name:
Owner Name: ,
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: fO
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator;
Operator Certification Number:
Back-up Certification Number:
Latitude: = e 0 1 0 u Longitude: = ° = 6 = IY
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
3 ❑ Layer
❑ Non -La ei
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
�t
❑ Farrow to Wean
I
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
[:IT k s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: FJ
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: ` — Date of Inspection EO�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Q
Spillway?: q
Designed Freeboard (in): ! i
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 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L No
LI NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination!
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
`Wecdrds neat 'OL
Reviewer inspector Name -, :: ` Phone:
Reviewer/Inspector Signature: Date: Z 42 2 Ls
12/28/0 Continued

Facility Number: 3 — In Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield. ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No '
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
C ah 111U'42' "2,je� hs- L
"7oaf S G' O odB/' ':�p I-L- ���o� /
12128104

Type of Visit )6 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 3 Tune:
Facility Number I
Not rational 0 Below Threshold
0 Permitted © Certified] 13 Conditionally Certified [j Registered Date -Last Operated or Above Threshold: .. ..
Farm Name:_ Q. -. W_ County:
Owner Name: _ , _ , . _. _... ._ _. Phone No: _
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: icdI ►"L Integrator.
Certified Operator:
Location of Farm:
Operator Certification Number:.. �� ...
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 9 69 Longitude • 4 64
DischaMes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
❑ 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 1 S 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number: 31 — C! Date of Impection
�. Are there any immediate threats to the integrity of any of the structures observed. (ief trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement. ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Aaplication
10. Are there any buffers that need maintenancertmprovement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving craps 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?
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?
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Cammenis (refer�ta�gaett:on �) �Expisan aYq''1tE5 aasvrers aa�ad/or� anY _ or sitY,�otlter f � -- �,. � - e
A[7sedraws of Party t4 Witter `'�_MIMP{tse it Pages as r9) field COPY ❑ Final Note
_ �r„,; wk-s.Yae'��''�L'^3',m...i�d _:^.�.uM._ Se..:.<�..,. x.....,�.� �,i.�.,w e•.ww.�`w. ...er^.-.s,:,_,.As:. 1��'.-�
..T;I 5 FeC-Rti Y1 Can etc *L rim % S eY re Y1 C
Cqu w-.' by Mr. Ivordt'Pq
9eC9C!e_- fiff -(:� a z42-- .¢- �ur-S
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Reviewer/lnspector Name =
ReviewerlInspector Signature: Date: %� )
12112103 f Itonrced

. 1Divisio i of Water Osahty _ ..
'4 � � •_ � � iJ: �nvisio3i or wu ana water �.vnservaaan� , « �.�,
_l _ z. i� Other Agency = =�X . ;
Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation i
Reason for Visit j2rRoutine O Complaint O Follow up O Emergency Notification O Other 0 Denied Access
Facility Number Date of Visit: Zt d T'uae:
Q Not Operational Q Below Threshold
Permitted Certified [3 Conditionally Certified Q Registered Date Last Operated or Above Threshold: ..............
FarmFarmN e: ....._...................................................................................... County: ty• _ s�P....__.__._._ -------
N e: . ......... . ...... ................................................................. ..............
OwnerName: _.. - _....._.........................................»................._..._............................ Phone No: .... .............. ... ...... .......... _...... —....................... .....
MailingAddress: .... ....................................... ........ . .. ........ .................... _ ........ - ---.�� �W_W_..._� ... ... ..._._. . _.....
Facility Contact: ..._.. Title: ................... ....._... Phone No:
Onsite Representative:
Certified Operator:_____.... _ .._ ._ .. .�� .._.._..._ Operator Certification Number: __.._ . � .._.....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 64
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ YesVNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........... ................. .......................... __ . . .
Freeboard (inches): q Z 3 4 J
12112103 Continued

Facility Number: 11— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes 0 40
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?
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?Yes
❑ IN9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes L't /00
11. Is there evidence of over application? If yes, check the appropriate box below.
ElYes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type CSO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management PIan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
KN
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes—fNg/
/o
15. Does the receiving crop need improvement?
❑ Yes
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 atlor below ❑ Yes o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes LdNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Comments {refer tt► q iestion') Ezplarn ariy YES ans�veis and/or any recoxmmertdahons oraay other- comme>ats. " _ -
Use draivitEgs of facih#y to better explain situahoas: (use honal pages as necessary}: ❑Field COPY ❑Final Notes A
e
�mm
LA �,00Q A NE cos muck wa P-C,6�cr�- . t A(10_0 J L
jJEEDS Sor•E wo�t,k �� 64L^s5 tJoV�l2,
P�DPt?6 Ca -'OF
T
Reviewer/InspectorName
Reviewer/Inspector Signature: Date:
12112103 d ` Continued

Facility Number: — Date of Inspection
' Required Records & Documents /No,
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes
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 N
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ElYes N
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? yYes�eNo,/
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
32. Did the facility fail to install and maintain a rain gauge? ❑Yes o
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes o
34. Did the facility fail to calibrate waste application equipment? ❑ Yes o
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 OCompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit IQRoutine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: z Time: I�.J
Not Operational 0 Below Threshold
® Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or bove Threshold:
Farm Name: ✓Pn .5mes l ' County: r i
Owner Name: A1""'�''_M%f✓/+� Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: _ Q/�i,_
Certified Operator:
Location of Farm:
,,PPhone No:
Integrator: !/lils'��y
Operator Certification Number:
ZI Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 " Longitude 0 0' 0"
Design Current
awine
L.I Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Number of Lagoons
Holding Ponds 1 Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -La er ❑ Non -Da'
❑ Other
Total Design Capacity
No Liquid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
Total SSLW I I' i
❑ La oon Area ❑ Spray Field Area
meat System
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: * 3 SiY>Z 1'* if
Freeboard (inches): 345 3'
05103101
❑ Yes 4 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KNo
❑ Yes 5�No
❑ Yes D4No
Structure 6
Continued

1,
Facility Number: ,j/ — �" 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?
❑ Yes 1�3 No
❑ Yes U9 No
[3 Yes MNo
❑ Yes 1ANo
❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes F] No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type _ _ A4_0141A& 1`I-r V .7M4I/ ,61 t �4wn ��P���D✓
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
U9 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 or other Permit readily available?
❑ Yes
IS No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
NNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ELNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KjNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
PS No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
W No
(ie/ problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IR No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
(A No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
C,No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cotiiments (refer tohquesaon. Explain ny YE nswers "d/oor any rec mmeend ans or any other comments ' _
Use drawings of faciility76better expWn situations. (use additional pages hs necessary)
.. ❑ Field Copv❑Final Notes
p,r^ V_ /�lor�g Zoo 4 e46C
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: z DZ
O5103101 ` "Y' 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 IgNo
❑ Yes 91 No
❑ Yes TA No
❑ Yes §.No
❑ Yes %NO
❑ Yes 10 No
❑ Yes ;S No
Additio©al Comriii nts aad/or�Dr'awmgs: = ,
i
611
05103101

Type of Visit . X9 Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit 9"ioutine 0 Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number % S Date of Visit: �O i Time: DAD
Q Not Operational Q Below Threshold
O'Permitted 0 Certified Q Conditionally Certified O Registered Date Last Operated or Above Threshold: ...
Farm Name: ai r`'!...... .. S ~..... County U ...'.!................................... .......................
�....................................
.......... ..... ...... .
Owner Name: v o /1►r T i i ..,�
......................f�........�.t.......................................................................-.• Phone No: ......................_..
Facility Contact:..............................................................................Title• Phone No:
Mailing Address:
Onsite Representative: J o �i �'t.... 'Z t C integrator: ^ ��..........................F—5
..................................................... •••...................... v..�....
Certified Operator; ................................................... ............................................................. Operator Certification Number:..........................................
Location'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ��;
Design Current Design Current' Design _ , Cai rent -
-Swine. Ca aci Population Poultry Capacity Po ulation Cattle capacity :; Po kwation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish r2❑ Non -Layer I I❑Non-Dairy
;r_ ❑ Farrow to Wean
❑ Farrow to Feeder ❑Other -
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars 7Total SSLW';
Number, of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 'WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 23'No
c. If discharge is observed, what is the estimated flow in gal/min? '.I A
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 KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,E9 No
Structure I Structure, 2 Str ture 3 Structure 4 Structure 5 Structure 6
Identifier: 14 Z
............................................................................
l..................... .... �... �. r.�.................. �...� 1.d............... ....._y:...4......d..�........
Freeboard (inches): 32 '•fs. S `t 1 36 ZT
5100 Continued on back

Facility Number: 31 — S Date of Inspection Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
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 dNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes JZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes A No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes � No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PANJ ❑ Hydraulic Overloads
❑ Yes ;'No
12. Crop type GO ''►� �11'laa- �e +.tiS ✓`z vLt� S Fr or.,11 1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Aanagement Plan (CAWMP)?
❑ Yes No
14. a) Does thefacility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes'ONO
c) This facility is pended for a wettable acre determination?
❑ Yes No
15. Does the receiving crop need improvement?
❑ Yes gNo
16. Is there a lack of adequate waste application equipment?
❑ Yes ,ENo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ;2rNo
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 PNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ,dNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yesi�_No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes 2fNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, Freeboard
❑ Yes No
(ie/ problems, over application)
,0
23. Did Reviewer/Inspector fail to discuss review/inspection %Oith on -site representative?
❑ Yes ,0 No
24. Does facility require a follow-up visit by same agency?
❑ Yes ,!fNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ,�No
•yi00006s:or• defclen.... were . dirri�g �hls:visi>� Yo>j� will receive d fu>Ftlter . '
Fcoriisb6fideike:
ibiy ltl•.Ws VLSI'. .'.'.'.'. .'.'.'. .'.'.'.'. .'.'.'. .'. .
Use dra W of-faclr to:better J . wuigs . _ty e8plam:situahons _ addrttonal.pagesasp"
nes�,sary)
The Of lekjoo^ &4 --4e 3 ),as bee-+z GloselA 4CGer�:rt� 4,o a-t'sq
re /�es�c .�;,,e f-�a�,.-�v�-, was-�e is ►esen in �a son, ��d ,s �k L4 4-�
-� 4 k* s wejoe wcivse d �{ � as 1
vr,rW Cj,aSV!'� �9�"oG[SS of rya+�k: `t h
cn•�J,Jw� e rj� III aJ!
be g o 11-04 40 f,elds.
'Me wileni Cr Ap is weII es-��b1;.�ed -
C ver'a ll , ft1-a -Fac 1 j� � y gvid eecs,-,d_S sire, well kepV
Reviewer/Inspector Name 5-%+�Qwg1 sj'yX
Reviewer/Inspector Signature: 4426ZKa Date: Lbl &161 S/0p

Facility.Number: 3 j — Date of Iaspection RqtEo Printed on: 7/21/2000
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes eNo
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 INo
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.) ❑ YesXNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )2fNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
5100
5100

;,Dtvtston of Water Quality - ty"
3 =
QDi�ision3of Soil and' -Water. Conservationfx
t h
�f _ ,r
D.Other Agency
{ e
Type of Visit XCompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit >57Rouiine
Q Complaint Q Follow up O Emergency Notification O Other
❑ Denied Access
Facility Number 5" Date of Visit: �� Time: I q = / 0 1 Printed on: 7/21/2000
Q Not O erational O Below Threshold
Permitted E3 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: SGof t`af.' �, •�i4e- �— Countv: b-ta-�t. .'..'.........................................................
................ .........?._........ ...................1........-....-....--..... I........-.....................
Owner Name: ...... ,U,r�!•)!-°j.~'?!..... 1`.°l`.�L5.................................... Phone No:......................................-................................................
Facility Contact:
:Mailing Address:
Title:
Phone No:
Onsite Representative: -...-.-- . G ��Q j � rof f ....- ----
[•t�---••---.�.1.... Integrator- . ...f��...'we�
Certified Operator:..................................................... ............................................................. Operator Certification Number :................................. .........
Location of Farm:
r
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Feeder to Finish 12,2 +� ej 4} ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons $ ❑ Subsurface Drains Present © Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System 71
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PrNo
Discharge orihinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes g�No
b. if discharge is observed. did it reach Water of the State? (If yes, notify DWQ) El Yes jRNo
c. II -discharge; is observed. what is the cstilnated flow in galhliin�' h
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 )4No
Structure I Structure f2 Structure Structure 4 Structure 5 Structure 6
Identifier: .....II .- ........................'T.-.!Ue.l .....3... %. W......-'._. E.d.. '.... I..-4---.�. ...-....... ...- Jd........-.-.
Freeboard (inches): T 2- b + 3� q S
5100 Continued on back

Facility Number: 3, —
Date of .Inspection 10 3 Printed on: 7/21/2000
5- Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
❑ Yes
8'No
6 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?
❑ Yes
JgNo
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
19 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Ed No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑,HHydraulic Overload
❑ Yes
�.cjNo
12- Crop type Ca f"i'7 , �ea� ,Sly ��yti S� �e ►^ YwU4 R,,X, y -
-
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
ONo
16. Is there a lack of adequate waste application equipment?
❑ Yes
-ONo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
ElYes
: No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
19rNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
10 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
� No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
ONo
24.
Does facility require a follow-up visit by same agency'?
❑ Yes
-PNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ErNo
0;Rio yiMbitioris or deficiencies were h6ted dialing this;visit; Voit Will •receive Rio; further • ; -
.... .. pondeirce: ahi A 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): j 1
q . L c,A a a 1� yvl ✓ �� ✓ S� o 1 p[ 'n �^a�6'� /' B % ii ST %1 G 4� i P1 e I
a 6fin Z .
"Ole- = Old lagOantV Grp _i4e q cv-'renf! be•�g r-ldsed
Debr%S meaA r 4e 6e �I �►? ea
C1a.s11P6 IS e vlele.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Kl atj 5100

Facility Number: 31 —S Date of Inspection 4 -7 Ql%1 Printed on: 7/21/2000
Odor Issues
2$. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes E5No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes %No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? JaYes ❑ No
Additional omments and/orDrawings:
S/00
S/00

7 D1VISlon o , 011 and„ ateF onSel`VatIOII eratlan eV1CWY: �3 c ° fi ;
�' � --(� Ii1nsian of Soil and Water Conseryat�on _Cotxipliance iiaspection .�"� ��-� ',� �-�� -
Y; �Ihvision of Water Quality Compliance Inspection �- ' g rs _��
r
Other Ageney Operation
10 Routine Q Complaint Q Follow-up of DWO inspection O Follow-up of DSWC review Gf Other - 1
Facility Number
4PIrrnitted [3 Certified E:1 Conditionally Certified [3 Registered
FarmName: ..... ......! "...............................................................
Owner Name:
Date of Inspection [Y— b? C
Time of Inspection Od 24 hr. (hh:mm)
0 Not Operational j Date Last Operated:
.... County:...... .. ..........................
Phone No;
FacilityContact:.............................................................................. Title:................... ............................. Phone No:
MailingAddress:.......................................................................`...............:........................................................... .............................. ..........................
..5.?.�fh ��............................................... Integrator: ..................
Onsite Representative: l 1
...... ............... ............................................................
Certified Operator: .................................................:............................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude • 69 Longitude 64
r Design._, 'Current' Design __Carie'nYDesIgn_. ; `Current,
.0 .Swine Poplation Poultry a_ _,Ca acityPo` ulationp
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design° Capacity ,
❑ Gilts
❑ Boars Total SSLw.:.
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Holding Ponds /,Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge ori;inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (II' 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
Identifier: I-' gL- lr3 I`�f j
Freeboard (inches): ..........vim 1- [ E i
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
KYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
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

Facility Number: `3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
1 I. 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?
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: Rio yiQlh0dris'or• &ficie'ndO$ were rtptec7 during this:visit' • :Y:ot1;wil1•receiiye iio further:::.
: • : • correspori�eince: abou>: this :visit • • • - • - • • • - • • : • • - • - • :: :
Comments (refer tq questioh #): Explain any'YES answers and/or. any recommendations or any.nther comments.
Use drawings of facthtyyto better explain situations -(use addttionalpages as.neeessary) ,
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
+-P_yd"-e 4CGA
t�oxe S Q
t7r^vtio Wit, �s ; ei,-e.
Reviewer/Inspector Name µ �- - .`.. ; •; � � _ _ � %�
_
Reviewer/Inspector Signature: t k Date: �- GO

w
t, 13 Division of Soil and=Water Conseryatioxi Operation Review = -
r
Q Division of Sail and'WaterConservaf.on Compliance Ziiispechon
:
pbiVision of Water duality Compliance Inspection
O�OtherAgency Operation Review _
- _
Routine Q Complaint 0 Follow-up of DWQ ins ection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection I I-b3-,f
y Time of Inspection 16 80 124 hr. (hh:mm)
Permitted © Certified [3 Conditionally Certified [] Registered 0 Not Operational Date List Operated: r ee ,+ T
JCDtt' County:.....-•).to.�l� y................................. Farm Name:..........................••-.-•-.�.J..W.�..---�---....................................-......................................-...............
Owner Name:._...,-...
Facility Contact: .................................................................
Phone No:
Title:................................................................ Phone No:....
MailingAddress: ..................................�..jj.......................................................................................................................M............................................... ..........................
Onsite Representative:.. 1..........}. ...l.V.11YY15... ti .... q 1. S Integrator: ....... 1.�..'. E............................................................. ..................
Certified Operator: ................................................... ............................................................. Operator Certification Number: ...................
15.
Location of Farm:
.................................................................................................................................. ............... ......................... ........ ................................... ....................................................
.�
Latitude Longitude • �' �" ^
- Design Current'Design " Current Design Current
rCCateSwine n appCapacity Populatany
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer
❑ Dairy
❑ Non -Layer
I
❑ Non -Dairy
❑ Other
-
Total Design: Capacity
_ 'Total SSM
�Mimber `of Lagoons _ ❑ Subsurface Drains Present ©Lagoon Area ID Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge Originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon systern? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge,
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: �/✓t►d l`L) (Nrw3) �,M,wLp) (p(d I } ( Dl.A L)
Freeboard (inches): •yq •1 . 11.I 35...
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 19 No
seepage, etc.)
Continued on back
3/23/99
❑ Yes Q9 No
❑ Yes
®No
❑ Yes
J4 No
❑ Yes
CR No
❑ Yes
® No
❑ Yes
® No
X Yes ❑ No
Structure o��,�{'�
�DI'l3)
Z�............... ice_

Facility Number: 13— S Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? byes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes VNo
&. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes IN No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? . W Yes ❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
29 No
11.
Is there evidence of over application? ❑Excessive Ponding ❑PAN
❑ Yes
ZNo
12-
} 1
Crop type , W , S13 Y-1
L -
13.
_
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
01 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
WNo
b) Does the facility need a wettable acre determination?
0 Yes
❑ No
c) This facility is pended for a wettable acre determination?
Yes
❑ No
15.
Does the receiving crop need improvement?
Pf 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
fR 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
KNo
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
$j No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
)@ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑'Yes
1K No
O V10Iaf)E[)RS,Of (�eflCleliClf'$ W TI 11QtE'a• dtWiAd Ois_vislt, • Y:ott Will -I eceiVe il0 fUI't�11rC ,
corresDonideRce:aboufthis visit_•:....::...............•...•.-.-:-6-.•.::.•.•:•:-----.•...•.•.
Coininents (refer to nesttnn #} Errplat�i any YES answers and/or any recomendations or' any otlYer comments..
q j r
Use:drawings of facility to }letter expiatn srtuahon_s (use. -A drttonal pages as:necessary)
s.
1Ag0Dr., Otw *till &-,vt tArk"t1 �A-reackeS ctsw+e�iwlnLt. _%VLr4� u P"Crf) wkt ALeY
�oY`oil0jv,5 Allow I
r�brt�#-intti� ��ay.5 G�oSC )A�PMG- � c116zd uD 4 r-r+b�� goes i►� records.
r d IAANSWa ty" � e D lot )aY1nw �`t
9 /~
ILA j)-6" e Gi kV( V00,A614 NC f tPS e De-\•wr
t� YIP � vtpe,r� �tA1n�P<C 9�G1 �-ald� C_cna - 111 l �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
3123/99

Facility blumber: 3 — Jr Date of Inspection �-
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes $No
liquid level of lagoon or storage pond with no agitation?
21 Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes k No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes Dd No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan btade(s), inoperable shutters, etc.) ❑ Yes D4 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes A No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes D'No
Additional otnmeqts'ait or rawings•?
3/23/99

0 Division of Soil and Water Conservation 0 Other Agency
,Division of Water Quality
M
JQ Routine O Complaint O Follow-up of DAVQ inspection O Follow-up of DSWC review O Other
Date of Inspection G Z
Facility Number ( S `
Time of Inspection 1 :3a 24 hr. (hh:mm)
© Registered Certified E3 Applied for Permit' 0 Permitted [3 Not Operational ry� Date Last Operated:
Farm Name . Fi xr County:........DSl. l.L...................................... .......................
OwnerName :.................. WV_ i ......... ..................................... Phone No:...�� � . 5 :............................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:.............:.....................................
MailingAddress: .... 311..... El!Yls...... G;Y.l1k .........La ........................................... .......I&Lsaw ..r...�................................. I...... ..........
Onsite Representative: ............ ............................................. Integrator:.......`
Certified Operator; ................................................... ............................................................. Operator Certification Number ..........................................
Location of Farm:
la.... ...... S% . .:...�. !' l.l. �.�........Y? 1.�,'S• .. I/LA ... .. .�2...........:....................................................................................... ........ Y...
Latitude �•.�� �« Longitude
.;Design Current ' Design Current 'Design .- =.Current;:
Capacity Population, `, Poultry Capacity .Population "Cattle Capacity, Population
❑ Wean to Feeder
Feeder to Finish
2: Z
Farrow, to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
;Number'bf Lagoons IHalding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area © Spray Field Area
fi
3 �>
❑ No Liquid Waste Management System
General
L' Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes [1 No
Discharge originated at: ❑ Lagoon" ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? Cl Yes [?tNo
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ElYes ElNo
c. If discharge is observed, what is the estimated flow in aal/min? tj
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes M No
3. is there evidence of past discharge from any part of the operation? ❑ Yes [3 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
t} Yes
No
5. Does any part of the Waste management system (other than lagoons/hoIding ponds) require
tQ Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes}
No
7/25/97
Continued
on back

Facility N umber: 31 — �— I
8. ;Are there lagoons or storage ponds on site which need to be properly closed? Yes ❑ No
Structures (Lagoons 11oldina Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structuree 5 Structure 6
Identifier: .._.......L ...(!�u?.... ..............ha:µ?....................4...xu!................._.i.l�.�p.].......... ........ .C.. 1.......... ........3 �. ............
�'`°ia�
Freeboard (tt): 1 2:: -1 2-�.:. .............. Z - 7........................2 :g................... -1- ' g
10. Is seepage observed from any of the structures? ❑ Yes JKNo
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 pubic 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, orrunoffentering waters of the State, notify DWQ)
15. Crop type.Y.l?,UCI.&.......................
CO.f.f1........Ir!..........5�.)�4(!t`-.................................. .............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20, Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit"
No.violations or deficiencies were -noted -during this.visit..You will receive no further
correspondence about this.visit.- " ; ;
❑ Yes 91 No
yu Yes *No
gYes ❑ No
❑ Yes 'N No
...................................
❑ Yes Callo
❑ Yes No
❑ Yes (} No
El Yes m No
❑ Yes MNo
❑ Yes [�ti`o
9Yes ❑ No
❑ Yes [ No
❑ Yes No
❑ Yes No
Comifients (refer to question #f} ;Explain anyYES answers and/or anF reconumeiidaii6ns or any other comments
UseNdrawtngs of factltty tci hetter;explain`sitt►afions (tise additional pa2es_as necessarvi . `
Oita aymr . 410,J3 be C'pse3 o,i. R `h�j of ease ouk thv4j Seth �}d
W+� toh. ```` 6V4_ ouf � DYE � q r� L�
( Z- CO Vikip- 00- V i� o r'-
` 1
r l
%& t4D k&yc,, 1+��r���7v\ C)J ! l oon, yLor
. S ►^e1taej� S� tl � vttk 6 fit, -f -ItJ6 rNLth6cr wi Ca►� c��acP2 l(S Sii�d[� t72
(R� l Pam{ trc (,C Vtl � Use[ its r Qi�- � WrtcQ Ca Cv�[� bh5.
dOCt1e an - t3 n 11.. �. ,/�r- �a�«i� S Sl vtC , i
11 ons %hOj �UL' � h V 1 i
CZ � [�c�p i'" � f
1
�a o0 h o s` 5 rtct7 'S • 7/25/97
Reviewer/inspector Name
Reviewer/Inspector Signature: Date:

IORoutine CamtaintOFollow-!E of DW!2 inspection OFollow-ueof DSWC review 00ther
Date of Inspection WJL411
Facility Number
Time of Inspection � 24 hr. (hh-.mm)
Total Time (in fraction of hours
Farm Status: t9 Registered 0 Applied for Permit
(ex:1.25 for I hr 15 min)) Spent on Review
[I Certified [I Permitted
I or Inspect -ion (includes travel and processing)
[3 Not Operational Date Last Operated:......_....
. . . .... . ..... . ..... . .....
Farm Name: County:._... 1X01" ........
Land Owner Name: Phone No: .... . ....
Facility Conctact:...�... . ... Title: Phone No:..
Mailing Address:
Onsite Representative: ..... ....... Integrator -
Certified Operator: f- V.L ".fsan Operator Certification Number:
Location of Farm:
..ESL
Latitude 9 6 Longitude 0 4
Type of Operation and Design Capacity
0! M
ilgh enta 41 gs
Swine
Design Pouf
urren t
oCapaor M
D Wean to Feeder El La er 710 Dairy
Feeder to Finish ❑Non -Layer ❑Non -Da
Farrow to Wean
'g
.... . ... ..
0 Farrow to Feeder eil I ad
'-p
10 Farrow to Finish s ''� TOtLW
.Jtp.
. . . M.,
M�
2, Drains Present Numberce
of 16a'go'dn's-I'Holdinge'l on s
JEJ Spray FieldArea
VU
t�±neral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon [j Spray field [] Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
110 Yes 0 NO
[I Yes Pg No
❑ Yes No
❑ Yes No
0 Yes
10 No
❑ Yes
No
❑ Yes
No
Yes
❑ No
Continued on back

Mility Number:.... ..._._ �.....' ..._
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Stir cturgs(lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure i Structure 2 Structure 3 Structure 4 Structure 5
Ll
..... .... ... I..... _.. .�...... ....... ...., _ :d... _.... 4. .
10. Is seepage observed from any of the structures? Jue i" 8 ocAj 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?--'�f��
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)
15. Crop type - ... .� ..... _......... ........ ..... ....................._leik&A............_........................... ......_....... ........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
Eor CtrtifiedFacilities
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes
® No
❑ Yes
[$ No
Yes
❑ No
❑ Yes
® No
Structure 6 &Jeaa ►+z)
❑ Yes
No
❑ Yes
JR No
Yes
❑ No
❑ Yes E4 No
❑ Yes ® No
❑ Yes ® No
❑ Yes [3 No
❑ Yes -No
❑ Yes ® No
❑ Yes ® No
❑ Yes fCj No
❑ Yes J@ No
❑ Yes ® No
❑ Yes PS No
C6ftii&nts (refer to question � Explain any YES:answers'and/or any recommendations or any'ather commentsqi
:
Use drawings: of facility to better explain situataons':.(use add�honal; pages as necessary)
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Reviewer/inspector Name
w ,
Reviewer/Inspector Signature:
Date: (D%lli7
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cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97