310035_INSPECTIONS_20171231

2 Vn
NORTH CAHOLINA
Department of Environmental Qual

irvision ofaWateiraResources
Dwision of'Soilnd Wa er Conservahon,g M 7 ,
� ^ -,K � s mob. � � �.z3 „. � •",�:
Type of Visit: Co iance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0. Emergency 0 Other
Date of Visit: Arrival Time: Departure Time: ® County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ('"i G 'C' &vf t S
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Denied Access
Region:
Certification Number: A Q�30 7
Certification Number:
Longitude:
Designer Cnrrent-ry, Design Current
Design Current .
` S e¢ Capacity
Pop � Wet�l'o ill, y .a ace Pop.
Cattle Capac ity Pop. -
Wean to Finish
Wean to Feeder
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 -trade?
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 �❑NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ Na NA ❑ NE
❑ Yes I� NA ❑ NE
[:]Yes ❑/No `❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Dumber: jDate of inspection: 5 0
re-
Wiste 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments rest, 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 VN ❑ 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 hio ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes <No❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [;'N ❑ NA ❑ NE
Yes .[:]NA- ONE
❑ Yes No ❑ NA ❑ NE
❑ Yes [� '❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
❑ Yes Vf No NA - ❑ NE
❑ Yes ��No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No : ❑ NA ❑ NE
El Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ CropYield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No '[] NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 3r I - 3 Date of Ins ection:
O
24%Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑'Tq—o ❑ NA
C] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
EKo ❑ 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
A
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 dNo ❑ NA ❑ NE
❑ Yes o ❑ NA [] NE
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes jNo ❑ NA [] NE
❑ Yes Q No ❑ NA ❑ NE
2 G , -- 3 K �.-�.� a �S %> - 4*-o c % s. #a.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 10
f �
Date: J A
2/4/ 015

C•r'4" r+ € :;• �! J-+-•,. r =- N-«:r{ i. - _ ;'J . : � . . �:- a -,tr n - A T- a: q :.x_,..
.. ivision of Water Quality
F c' Nui ber F3T_11- O DivisionofSoil and Water Conservation
0 Other Agency
Type of Visit: 9 ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ,0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
' Farm Name:
Arrival Time: Departure Time: CO County: , ,rD/) Region: (i Jf
/1
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: aP���
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
a :Swine : Capacity Pop.
�. Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
.Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er I I :A
Non -La er
Design Current
Pullets
Other
Longitude:
'Design Current-
Cattle _ Capacity' 'Pop:.'
Da'x Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges -and _Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes'
ff No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
.
a. Was the conveyance man-made?
❑ Yes
](� No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E3"No
❑ NA'
❑ NE
of the State other than from a discharge?
t
Page 1 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
Waste Col[ection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2"No
[DNA
ONE
a. If yes, is waste level into the structural freeboard?
❑ Yes ,7rNo
❑ NA
❑ NE
Structure 1 Structure 2` Structure 3 Structure 4
Structure 5 Structure 6
Identifier: f" � T
/—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�� T�
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/ETNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �❑i "No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Eno ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [Er —No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 2fNo ❑ 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 EJ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,[allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,❑"No
❑ NA
❑ NE
Renuired_Records & Documents
19. Did the facility fail to have the 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
EJ`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 [,—J.AIo
❑ 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 .ETNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PI —No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FacHity Number: -�7= Date of inspection: A;Li
24. Did'the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 ❑ 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments. (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: A 4,/701
Date:
2420111

(Type of Visit 00ompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit oRoutine Q Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
f
Facility Number ate of Visit: 2 t9 Time: �
.3 �' D
Q Not Operational Q Below Threshold
Permitted 13
``Certified 13 Conditionally Certiifie/d� © Registered Date Last Operated or Above Threshold: ...........
Farm Name: WC�!5...�� n f ~3� �� r"i !C ; �2'��t i �L........ Countv:_..'_._t..!'!....................... - - _............
........./........I_ ....................... .................
Owner Name: ,,•„•,,..•,�;f 1'L M G S Phone No.
...........................................................�.................................................................__................_....._....__..
Facility Contact: ..............................................................................Title:.................... Phone No:
MailingAddress:.....................................................................................................................
Onsite Representative:.,;' 1.! y,.-._.-t._ . ,G Integrator: ..... 611. r ..... . ' �] ..............................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
J'r
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��° Longitude �' �� �64
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 11EILagoonArea ❑ 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 A!fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Z No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 4� No
c. If discharge is observed. what is the estimated flow in gal/min? i•j /A
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes /ElNo
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 )ECNo
Waste Collection & Treatment
4. Is storage capacity (feehoard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldcntifier: .............. ti �' �.-1 ................... f. ................ '''...:........................................................
Freeboard (inches):
5100 Continued on back

Date of Inspection
4there
ere any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
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)
i. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding PAN ❑ Hydraulic Overload
/s ex ►-n U 1 I&Z-e � <c
12. Crop type _L•4 �'t't.�l�� �el'i� Of� � t _ � In
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes JOINo
❑ Yes 'p"No
❑ Yes�No
❑ YesZfNo
(3 Yes )31110
❑ Yes �No
Yes ❑ No
❑ Yes )EfNo
❑ Yes _;3 No
❑ Yes,)!fNo
❑ Yes 0'&o
,ErYes ❑ No
❑ Yes/EfNo
❑ Yes E�No
❑ Yes,,&No
)dyes ❑ No
❑ Yes VNo
❑ Yes ONO
V -�.•C
❑ Yes j�No
ClYes/ ft
❑ Yes eNo
❑ Yes;zNo
1. yiolatidiis:ot. deficiencies were poled- dit3:ihii this' SIC • Yoo will >receiye lio fptth r
correspondence. ahotit this .visit.
:T:
Can�ments {refer to question #k) -Explain any YES' answers and/or any recommendations or any other comments.:
r
Use drawings of facility to better explain situations {use additional pages asiecessary) T
- E
FAN otc-f iel,4 2 q� 514, 6 t 9lbs #
�� 1�51 Gf1•^<{ %3 • � 1� S�c,G�'e Y^es�eE.� � re,) [�L^ �C t'" i Ct�Y'i? . 1 .
1S. U00,_,row 0 V e rI'-<- &V(2-w c
21 Z �lt� l- s,'��. l✓�r1c
Reviewer/Inspector Name 6p!-i
Reviewer/Inspector Signature: Date: d<Z- / l� - 5/00

' ',ty r umber: Date of Inspection Z [1
.or Issues
A. 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? ❑ YesXNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yeso
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the Iiquid surface of the lagoon? ❑ Yes10
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'AEr'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ErNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No,
Additio comments and/or ra*nngs
AL
T
5/00

Type of Vfalt -O't;ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for V1sitXRoutine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 9 f Time: t
Facility Number ,3 �'
Not Operational O Below Threshold
13 Permitted © Certified 13 ConditionalllJy} Ce�rtAifie/dd ❑ Registered Date Last Operated or Above Threshold:
Farm Name: �"+a{s L}fn �� � + 6 '"[ I(..'.'�� �� �� County:.V.V..L.L.h.................................. W... `_.
..... ..... fit ............................ .. ........................
Owner Name: u �1L�7.. Y.ei'' y... . �k ................................................... Phone No: ............... ......... »...................... _.......... ..
FacilityContact: ................................... ............... ............................. Title:................................................................ Phone No:
Mailing Address:
Onsite Representative:.. 4.! ►.. }-- 2 i G----- Integrator: r • t 1J.
............................................. .......�o.. 7
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
r
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��° Longitude �• �� �«
.., Design- Current . : Design Current Design ' Currant
Swine .Ca aci ` Po nlahon.: Pnril
°:° ` Ca aci _ Po ulation , Cattle Ca i►ci Po ulaHoe .,
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars F=L 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 originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structu 3 Structure 4 Structure 5
11 c
Identifier: ..........,[.�.. ..................... ,3.t..1,..✓._..............M �...................................................... .1...........................
Freeboard (inches): X 7 3
5100
❑ Yes eNo
❑ Yes d No
❑ Yes )! No
A
❑ YesKNo
❑ Yes ['No
❑ Yes ZlNo
❑ Yes j2No
Structure 6
Continued on back

Facility Number: — 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 maintenancelimprovement? .
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?ii ❑ Excessive Ponding 0PAN ❑ Hydraulic Overload
r'�L
12. Crop type Co �rs�i Z &4 , [ Aq6 1'ef 1Qr-&Z 4? tti
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection 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?
Mah'jis'er. dglieiencies rvre nd>trritig this'vj'sjti Yoh yviijeetrive to futthgr
correspondenci aNDuf this 'visit:
❑ Yes J?fNo
❑ Yes 010
❑ Yes o
❑ Yes_A!TNo
❑ Yes )2rfVo
❑ Yes 250No
,9Yes ❑ No
❑ Yes )E:rNo .
❑ Yes Mo
❑ Yes;j�No
❑ Yes 0140
.0Yes ❑ No
❑ Yes;dNo
❑ Yes EfNo
❑ Yes,,EfNo
Yes ❑ No
❑ Yes WNo
❑ Yes ONO
❑ Yes�NO
❑ Yes No
❑ Yes No
❑ Yes;IeNo
Comments (refer to'questioa #):.,Explain any YES answers and/or anyrecomntendation. orany ottlier co�nts.
Use drawitigs`of facility to- better eicplau>t situations (use additional"pages as necessary) =
e
/!' 0V tf,gPf11'c10'e-�, of FAN do-(eld 2 PvIIS 415� � 6 b� 1D. 9lb s
�� rbs! a 13• q !6s/ucee res feel' ed, el. Z oDl ctp)wj� .
1 S. Wo orI� �o ► ••� n� sc � a � n2al G�� o n Fi Z & -Itt.e 1 ' �- s,' •je - tVer k
_k ;'Ayrn)rc ^ a4ur, aa, ,-i tot -side off' I':e/d Y Q fAe 1-2. s� .
r
' 1- /V e ed /e we we#a bl'z ae _-eS eh
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: z �W 5/00

Facility Number: j - 3S Date of Inspection 2
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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/ZfNo
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes INo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes MNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan biade(s), inoperable shutters, etc.) ❑ Yes RrNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes ❑ No
5100

Facility Number 3! 3$ Date of Inspection DU
Time of Inspection / : / S 24 hr. (hh:mm)
© Permitted © Certified 0 Conditionally Certified [3Registered 113Not Operational I Date Last Operated:
Farm Name: .......... W. I- tY 5 r r •n County: , v "1
Owner Name:.. L'f. 1L,....1`q.''� . 1...................................... "`r Phone No -
Facility Contact: ...:............................ ................................... Title: Phone No:
MailingAddress: ............................................................... .........................
Onsite Representative-; �n e;?' W '64--r-r �sfy i 5 , A/�o., M. b `YIntegrator:..'•:.r..t� � `;.w'...� ' ''t t
......... .......... J ..1° ._....
Certified Operator: ................................................... ........................................... ................. Operator Certification Number:..........................................
Location of Farm:
Latitude =` = G{
Design ,, ' . "Current
=3wine -Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude
Design -Current'_ °Design:.:. Ctirreot
Poultry Capacity - Population 'Cattle ,
Ca aci Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
Other
Total Design Capacity.:,
Total SSLW
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? E§ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:'"] 2
Freeboard (inches). ..........3d....................._...........
....................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3123199 Continued on back

Facility I'fumber: 31 —35 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
? ao
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.. . .viol. . . .s . .. ... ...were noted during this:v....Y. . will .... a do further
corres�orideike: aboi i tf this :visitL. .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes 19 No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question #)f Explaiq any YES answers an or any recommendations or any othereomments. -
Use drawings offacHiN.to.bett&_.explatn.sitdaiboas (use=addrtional-pages as,necessary)
=P,rloc�ioh conr(vI'c�e��0r rh res�o»x)e �d ct �oncJGai1 �ro.,,� l7'jv
r'ssp/e5en�ti'i�l=;4T q di SG�lctnye l�,ad BGGv/�e�l GI�lte �c{Gi�1 ��1,1 1
Zt. V-1d. ivvtnd broker, „roe 4n-f if rg---� ovc AkN ald ;r f';I2 iQ� �+� s-��►,,,
which d;rC'ka►^ ed 4m Ipn uylnot eA 4'� 6v4aof
!✓i r�h � s C'-ee_k _ W'f4cY' Qv'11` Iy YA0-r ) es ,4 i c�t�res L'V e-re J'q kce —
s
�s 'A o-m •;4e rcpr -�o c1e�,tkNVP waske ��.,� Gottu be j.1AG''e '
G]ejn tr/o b,.ietf 1,J f �� �vr,'�9 ��2 !nspe�� ;art • '
Reviewer/Inspector Name _ ` 1 10 Y� c t✓R.1 ] _ ,'Q'}G,
Reviewer/Inspector Signature: fl -�MDate: ?171oo

31 35 (7415' A-. S 9-1141- (,11kf4e plan)
10 Routine Q Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 2 3 Date of Inspection
Time of Inspection 24 hr. (hh:mm)
[3 Permitted [] Certified [3 Conditionally Certified 0 Registered 0 Not Operation Date Last Operated:
Farm Name: l'V] Y✓i /,�Q c rI 74 ✓• k- County:..._"^soK..................................................
...................................................................................................................... ....
Owner Name:
Phone No:
Facility Contact:.............................................................................. Title:................................. Phone No:
...............................
MailingAddress: ....................... .....................................•-•--_-....................................................................... ..........................
Onsite Representative: r G h tie) AV 6" /` l Integrator:.4 V. !' ,,,,,1� �. �'.'!'?. s
..........................I.....I...... ... ....
Certified Operator:..................................:............................................I................................ Operator Certification Number:.--.......................................
Location of Farm:
......... ........ .... .... _....... .. .......... ......
Latitude �•�j �« Longitude
.•,.
_Design Current Design Current Design ' Current
Swine - Poult .
Ca act Po `ulation ry Ca'aci Po `tilation„ Cattle Ca act ,`=Po -Mahon
ty.. ty ty
❑ Wean to Feeder T ;; ❑ Layer ❑ Dairy =
Feeder to Finish 3 S � � ❑Non -Layer 1 7,10Non-Dairy
❑ Farrow to Wean------------
❑ Farrow to Feeder s ❑ Other ,
Ej Farrow to Finish Total DelignCa aei
❑ Gilts -p
❑ Boars a _ Totai SSLj.
Nttinber of Lagoons 1 ❑ Subsurface Drains Present 110 Lagoon Area JE1 Spray Field Area
Holding Ponds / Sold Traps:. ❑ No Liquid Waste Management System _F ? s
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2, Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: +
Freeboard (inches): `3d
❑ Yes Eg No
❑ Yes ® No
❑ Yes JR No
r)la
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes �3 No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Jc No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 8Z — Date of Inspection ID 04
6.- Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? . ❑ Yes 0 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 10 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 IN No
Waste ADDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ��"" ❑ Yes I@ No
12. Crop type .S y h e A n 3' , W i'Lc a � , F. „,t„ dr, 6rA7 e , 'y1G� 4-t, 4 C ra Z e , 1'1'13 //e I-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? [:]Yes B No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
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?
Renuired Records & Documents
IT. 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?
i' ,O-yiolati6iis:or• defciend-m' •vr�ere ngte4. Ot�iitg his:visit: You Will -receive iio fufthgr .:...
corresporideirce about this visit: ................................
❑ Yes ❑ No
❑ Yes ❑ No
H Yes ❑ No
❑ Yes IN No
❑ Yes .0 No
❑ Yes V No
® Yes ❑ No
❑ Yes El No
❑ Yes 9No
❑ Yes S No
❑ Yes R No
❑ Yes fO No
❑ Yes JO No
�7-/irs % Wq4e,, rs �o :✓t9 iP)4o sIt -lta n kr 6,/,K1d have ant ove,nvl;�� �
17 no49. F." c r��vs�—d�Lt�rr�:f[ S�tarhj�
1S Sa ybecr'1 �'; c�d i s r'n�cs-�ed 1.v: �1, i•'I scG�s ��ts-�;c��(e S�o�.jG{ 6e Us�•
ern s u. �vvGJl r���d o�l So� 6��n� , err; cta-� c bezin/ s Soon . Iy
qL new S� ; 14 �o/ sot��e4'2��lNc%l 6�� e n t rej� U� L � in,Md>te�/
.-d1 an j;fe. Need o
s� W t1; G4 1✓a oor_ i 1 �e;,V I)reLt on7:W/?- Z' f _1; use
Reviewer/Inspector Name Jz,
Reviewer/Inspector Signature:^ ,�,{, yvytJf �� Date: / ,10

Facility Number: 02- — 6 `t 3 Date of Inspection ld t?
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below to 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 EN No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes ❑ No
Additional Comments an of rawings:
I,vr� Q��l l s,' s- L✓as-1e ��l��t 1z�s geld Unc� a s Z ZS�c��S �,�,
��a^t yCr�''' ►�-tq� .�ilvt.J3 �'� C�c{ f ZS.ZS AGrq--r. �ec- - i9l°1,-7
Ve#4ble acy-e S.
A

Facility Number 3 1 3 S
Date of Inspection r7 1 a 00
Time of Inspection I If'-0 124 hr. (hh:mm)
® Permitted 0 Certified © Conditionally Certified 13 Registered 113 Not O eratianal Date Last Operated:
Farm Name: ............. .n't..........r5 ............. County:O i �'`1.................. ...........
r
OwnerName m t?...� It : i 7 �R...................................................... Phone No:.......................................................................................
Facility Contact:.....................//......................................................... Title:................................................................Phone No:
...................................................
MailingAddress: ...................................................................
Onsite Representative:...!,G %Z a e I .....& o� r , 5...... Integrator: ✓ �' '"� .'• ] `I �q r.' "L
.....y.................. f
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude • 6 46 Longitude ' ' '°
Design u Current
Design...r rrent , Design... 'Current
5vi7ne _ :Ca ace Po ` uli3bon Poultry Ca aci Po 'ulation., Ca#tle _'..Ca self 1?o tilahon
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 2 0 2 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean _ _ _an
❑ Farrow to Feeder Other -
s ,._.
Farrow to Finish Total Design Capacity
❑ Gilts -
❑ Boars Total SSLW-441
Number of Lagoons 2— ❑ Subsurface Drains Present 110Lagoon Area 10Spray 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 10 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? Kist
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 Ej No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Ec No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I -b Z 3 -'S
Freeboard (inches): 30 2q....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes IffNo
seepage, etc.)
3/23/99 Continued on Lack

Facility )lumber: 3 / — 3 5 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? /�❑ Excessive Ponding n PAN
12. Croptype .9ee,,''l v,4ej era zc, 111g4 'q 6MZ-e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA
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?
❑ Yes 0 No
❑ Yes ES No
❑ Yes 19 No
❑ Yes ® No
JZ Yes ❑ No
0 Yes ❑ No
r—_ybeortlr w r) C4T
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
10 Yes ❑ No
C3 Yes [];No
Required Records & Documents
IT. 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?
3:. �4 •yiolatigt�s:oi- ftfjde' 3nUes were note#- il0itig �bis:vis .' .:Y:oo will •reeeive Rio further"
• corresaoiidei 'e:abO' i1fthis visit. .:..:.::::: :::::::...........:.... .
❑ Yes §0 No
9 Yes ❑ No
❑ Yes ® No
,® Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 0 No
^2 (.ags-1�e jabscrved �'►� !.�►�¢�1YLQI�GY�U✓sal_rCarn 717�Dp a{;r��rn�<
1 GDv1Tr4r 1/Q�jG,�R�iO� aGl �-4rkt` �i1�GlII 6Y CIJq-�Eis 3JS
d�sffG�l1cnge �o.s•vr�'�Ge 1
al rlot .S,10 (A W kl z) l A" V e t ✓A S7 Gt ?a� � i �d Tp T � 2'r''l � S f' �� U i ,+,ed t�
L'� of S I e � I A vi sn s;-�va.­-b ok, i n V, _ (A Z of Cv o 4- ,t b 2—
11
n v en, w a t o v e r a c C '-AV • �l�n� A„A�1��1c � �+ g t��l�•� -�o I �� r � zi' e"t
1,b z .s r4e I r-; ¢ 14 1 Pv11 12- 6 y sWACo- F;'L-Id 2 !`kill is .
Reviewer/Inspector Name 1 e�✓ l �x� t, f -_ - —
: Sao h. R- —
Reviewer/inspector Signature: Date: " ( 1,o®O

Facility Number: 31— 3 S 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?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
2&
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
effNo
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
9 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
19 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?
10 Yes
❑ No
Additionalotnments an or rawtngs: - - -' ~�` i•;' z :: _�.Y -
��,4;1 is pehd ed rofo✓1-
I s v e a W or non be r evL/4/ �va ssas in ��'tIdr .
15. Be,►Nt Ude �c J
W Q�))k �a beer es�klbl<J�. �er/mot-.��1�, -1, remd,/�` o�17cr J�i.tsQs.
Lt%q-t-Cr•J � .% Z �r"EId � haS I�BCl7 rnr•�gCr�! Wr'�Lt �frt,V(.�Li �T t S
4, be la►�Ped in W1a4,. !►'1 �c1{, Oe c��;ovs cwhen s�Oq�;r,�c in
�i„1 �;eloi why"fe Az
1l er•e qr= S-1'P Qla) n� b�r'c c,re�s. fills®� pan ��
F' e� f G S � n-1-�-1 r ,rc
by c� n+5 4d ;.IV 'Fl , � 6 V , � Ll � s �� e �� ct t W q 1"r/ q t�
I e%""t�da G6�a ��ct,n�rr11 s4e6l41 Ts q )/ 1
4? j r3-5 �qS Hawn �� �t Sawt� ►"L.1/eT
baG-h �s / 1 9 5
�1R S been 6vAliac�c,ed -f® ec�° dDw� STa I�S �CCO�� �/�" -/ �c�Pr ser, a4�, ✓P.
vv,,��__ �v,pp IUaW r��tS�c✓ 44c,,, CO /S Lt�e 4�Ia 7d �lRZL should be
�Aeld �60e,4 el'- �-30�' e CoW S Of TO "IP Vf
Theye ;J q srn-"11 bore gfcl ►n bc.^1'LI44 cld r7le, "egve�jro�d
on 1,,� {�.r 3-5 �ile;ffWRe �o Gs�Gb��h be/"�'Ju6(,q ,?-.e -
t7. 1^JA�c✓S ��J Pe►�rti;T l f JlO� Q✓1 S,- � . G.1� 11 -,-g� seNd Gory
�t Lin
19. CJaY74e 61W 1ai m.tp�r'
shows As 39.0.7 acr-s. roc ise A-�6 glace W%f�
i�'c{y��,oY, "c�c'SiGjn". L✓Rs-te plk�+s►1nt,✓f geld Unc' as ZZ.ZsgC,Y,
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�,s-�)Ti��v,s�pW�,.,c� la�aon is ��►mot, p�'^���d�'+^a� a�lal vse a�ra�s:��-e

Operation-Rentew
13 Division of Soil and Water: Conservation - - -
- "w Division of Soil and :Water Conservation 0. Com fiance Inspection w ,.
P.
y - jxDirlsion of Water Quality CompilanceIspecfi©n.= _
E Other Agency, OpinitionTReview _ ..
III Routine O Complaint O Follow-up of DW2 inspection
O Follow -tie of DSWC review O Other
Facility Number
Date of Inspection.
j®"
Time of Inspection
y 3 24 hr. (hh:mm)
Permitted jo Certified (3
Conditionally Certified
© Registered
JE3 Not Operational
Date Last Operated:
Name: ..................
�.A44s.5
4-U �Y
.h�,c�....................rk...........................
_ . County: ........�Vl
?.i !�...................... .Farm
Owner Name:....... 1!1.1. ?4�! ..................
1... AL.ni y...........
rlly.W5..........
Phone No:
FacilityContact: ...........................................:..................................
Title: ................................................................
Phone No:
Mailing Address: ........................ .......... "
Onsite Representative: :1'Pkn... [,� r �.. .. Integrator: L.:1.......................................................
......... ..... ....................................................... ..............
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
A
................................ ........... ....................................... ....................... ........................... ............. ................ ....................... ........ .............................................................. _.........
Latitude =0=1 •• Longitude • 0` ="
;.
Design Current W. Design Current F; Design Currrent
Swine--- _ -
Ca aci Po ulation Point
tyy Capacity Population. - ."Cattle Capacity Population
❑ Wean to Feeder
® Feeder to Finish
tt 15'
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
EE
Nuutber of Lagoons- ❑ Subsurface Drains Present 10Lagoon Area IDSpray Field Area
0 _..
oldiiig•Ponds:7 Sotid 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 than -made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is. the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? . ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: rr..
Freeboard (inches): .............Jr..................3.c ....................... Y.......................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 0 No
❑ Yes [R No
❑ Yes [Q No
N
❑ Yel DQNo
❑ Yes W No
❑ Yes ® No
❑ Yes Cj No
Structure 6
❑ Yes a No
Continued on back
3/23/99

Facility Number: 3, - 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?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste. Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
I _ IN
13. Do the receiving cropsdifferwith those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Nb-' iMatidFis;ot- deficiencies wlere h6fed• d&ifig �hisMsit;. Yoir witLkeO irce fid turth' ;
ctirres66fidence. abaulk this visit.
❑ Yes EA No
❑ Yes V No
❑ Yes ® No
❑ Yes ;K No
01's VgNo
❑ Yes KNo
❑ Yes N No
❑ Yes ® No
® Yes ❑ No
® Yes ❑ No
D4 Yes ❑ No
❑ Yes P( No
❑ Yes t.No
❑ Yes ;9 No
Yes ❑ No
❑ Yes IN No
❑ Yes ® No
❑ Yes No
❑ Yes J$J No
❑ Yes ® No
❑ Yes CA No
Com cents (refer to-quesiiou #) `Expl'att any YES answers and/or an recornmendahons or ainy other comuntents.-
Use:drawings of.faciltty to better explatn_situatiiiiis (used additional pages as necessary)
/¢. i�rtnti :s tinDt►ee� 46Y wt}"ble.O._tep je Aw*,!op_+orL. N?e a. rov+ ot-l-c iatires.6e _Ok
.
Wek�ble �yfe, s11cw3 }cup+rnk�,i aPpe&rs ►►.ca,+tielGke_.
-�-
15. nerds ex-��u►S��c_ Iw�k-�at�ot c'overa��- +tends i1P' f W�
014V WA ;n -t'1elr (M) �tf.dt tom? yoven,,ew N eA -h be esIA4 ��/
Xyplr, YfJPv, t 17 AiYPa*- 4'w-
�rk� Ybl� t��rc�- -y r�cc�,��� C�� J
W Caw ww OVY ,
Reviewer/Inspector Name 1r fl ✓ , �.s _: �: ._ .3
Reviewer/Inspector Signature: , 4 Date: -�
rorre✓ --,i OIO M6`3lj0 .1, (DWa) 3/23/99

Facility Number:
hate of Inspection ;(ja
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? '
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
OkNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes,
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
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
Q No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
( No
[Nddiflortall Counnentsandlor,-Drawings _ ry
W�
A.
3/23199

Facility Number Date of inspection
3
Time of Inspection ffq 24 hr. (hh:mm)
0 Registered. M Certified E3 Applied for Permit © Permitted 113 Not Operational I Date Last Operated:
FarmName: W.......'!+!......... ................................................ County:....... 7u?lm....................................... .......................
Owner Name: r��vy..........1b.3.1�1...... ... �A YIu�s ..................................................... Phone No:..�.!flb....�.�'�i.-. ZI.�..............................................
Facility Contact: ........ % y.......4x1.................................. Title:..........er-
............................. Phone No:...................................................
MailingAddress:...... .D.. Ji..,.. ? 1....................................................................... .... ............................................... .. ........
Onsite Represen
tative:....... 0A.Y.1...... C.. ............ ..................... Integrator: .......... Ad,vrtA, .........................................................
cl-n a 1-1
Certified Operator c.................................. ............................................................. Operator Certification Number, ............ I..Q v-
Location of Farm:
.... ......... ............................. .. .....---....-----.------ -
Latitude 0• I�4 " Longitude ' 04 "
,.Desrgn, Current
❑ Wean to Feeder
00 Feeder to Finish
❑ Farrow to Wean
°' ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
;ign " Current
acity Population
f❑ Non -La
-I❑ Other
Non -
AU Subsurface Drains Pres!jtjjU Lagoon Area 1U Spray Field Area
S F
❑ No Liquid Waste Management System t
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Q No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [2 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes (9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes CM No
5. Does any part of the waste management system (other than lagoonstholding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ( No
7125/97 Continued on back

Facility lumher. 31 -- ti
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Ilolding Ponds, Flush Pits, et6.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Stnicture I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft): ............. .`4.............................................................
10. Is seepage observed from any of the structures'?
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes W No
® Yes ❑ No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DNVQ)
13. Do any of the structures lack adequate minimum or rnaximunt 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 y r, U � °� ...........................SMA ��...�Yir,n................... . ...........-.-
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?
1
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 091
23. Does the facility fail to have a copy of the Animal Waste .'Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations or deficiencies r ere no' te'd-during this. visit. You4ill receive no farther
correspondence about this. visit'.• .
...........I ...................
❑Ye: [ No
❑ Yes No
[V Yes ❑ No
❑ Yes ® No
4
❑ Yes ® No
❑ Yes
No
❑ Yes
IN No
(� Yes
❑ No
❑ Yes
PQ No
C50Yes
❑ No
❑ Yes
No
P Yes
❑ No
J4 Yes )KNo
°Yes [ No
❑ Yes ® No
Comments` (refe'r to question'' Explain any Yl✓S answers an d/or•any recom' mendatitins:or any`other comments
Use:drawings of faeility to better,explain situations. (use additional pages as. necessary):
O_zb - Loyc�, 5i3Ould 6 louw--d kv mvvtj 9,4w&4 rc.%ann S a 4e
Dina (�+rav�.n.e.r
�a. g�,t o..�•S sko�ld �� e -&d Cm k,_ ate a,, ovk" az wFl1 sha��`nc wcse����-
tC . Qtvmv�� -Vv9 s�0+4.4 tywA�(C J J SQ,rf.'3 e f "4 �.
'6r` �r �tt� nv�er, �[3,.� �o{mot o�,rcl�-
20 s &j VCtOT % t�uia "� Sew ��� _l�-r- ,
i3aS��q C.Ac-vi *or's1'p A S1Wv`U 40� JSid �f 2aC h C.rop- .A ,,, -,,
b aver s -PAN oP Z"iSp pry 7.3S .
feu �ccrrds 1�C r�— 1�- 23� �p rJ ; r. W L1Q i w;�s Gar �-iL ;� 7/25/97
l
�
Reviewer/Inspector Name ZO
P�ria L. Iw4�Hkk _
Reviewer/Inspector Signature: / . �'� _ _ Date: �ulg8

ivision of Water Quality
Faculty Number 3 0 Division of Soil and Water Conservation
0 Other Agency _I
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J:)4outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
22Date of Visit: Arrival Time: U� Departure Time: r ounty: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
J Owner Email:
Facility Contact: Title:
Onsite Representative: d/%ifs
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
nPhone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = ` = " Longitude: ❑ ° ❑ 4 ❑
Design Current Design Current �Design Current
Swine` Capacity: Population.. Wet Poultry -Capacity Population Cattle.CapacityPopulahon
❑ Wean to Finish 10 Layer
❑ Wean to Feeder 10 Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
"Other`
❑ Other I.
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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 Cod
I
Number Hof 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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
El NE
El Yes 91No
❑ Yes ,fNo
❑ NA
❑ NE
❑ Yes )2?No ❑ NA ❑ NE
Page l of 3 12128104 Continued

Facility Number: -� Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus -heavy rainfall) less than adequate? ❑ Yes ;?I'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [D Yes [] No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ 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 id No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9,No ❑ NA ❑ NE
S. 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 I/I No ❑ NA ❑ NE
maintenance or improvement? i
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
F
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, 40)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ONo
❑ Yes ZNo
❑ Yes VrNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
[:]Yes
PTNo
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [7No
o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WIIP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C2 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 ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili ` Number: - Date of Inspection: .2-J
24. Did the.facility fail to calibrate waste application equipment as required by the perm? [:]Yes PrNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes V"No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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
No
0 NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes VrNo ❑ NA ❑ NE
❑ Yes [; No ❑ NA ❑ NE
❑ Yes [ffNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [!XNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes VNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or. any. additional recommendations or- any, other comments ;
Use drawings of facility to better explain situations (use additional pages as necessary).. p'
._. � ter....
? ea/� /!ems k1 be .5ze4�inIAoO` {vim �/Q�.f 3
tr, 6VWT_ e_ 1-,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
[i
Phone:
Date: Ire
412011

0
II
Facility Number
,--j, L
d—
ion'of Water Quality
ODiAsion.of Soil and Water Conservation,`
Other Agency
Type of Visit 32 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: d Departure Time: County: -Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ��//ff Title: Phone No:
Onsite Representative: �I�% Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o ❑ f Longitude: ❑ ° ❑ , =
Design. Current. , Design- , Current' w esignt Curren#.. -
Swine Capacity nPopulation -Wet Poultry W Capacity ,,Population,, Cattle Capacity Population
❑ Wean to Finish ❑ Layer
ElWean to Feeder ❑ Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean
rDry Poultry, _
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ 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?
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
•° Number o�
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?
xl
❑ Yes O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes{SNo
❑ Yes
EI No
❑ NA
❑ NE
❑ Yes 1CJ No []NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection d
` Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 2 -1-7
^�
❑ Yes 2 &o El NA ❑ NE
[I Yes -�I N- o ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [2-No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes .fNo
❑ 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 C:-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 -E'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Pxo,
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
��
El Yes IT No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 tbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of
Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes _O No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .,ET -No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes E' to
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes EI No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes El"No
❑ NA ❑ NE
Co inents. (refer to;quest�on-#).'wExplain,anv YES answers and/or any recommendations or any other comme is "` t
- r.. -
Use::drawings of facility to better explain situations. (use.additional pages as -necessary)
d l�P4 h 7L Z--. Alf
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: f'e asi
Page 2 of 3 11/28/01 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YesJ2'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes -15No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 12-N6 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes J:iNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes J2<o
❑ 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 ,2-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ZrNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes .]�iNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes -0—Ro
❑ 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&Ro
❑ 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 Q<o
❑ NA
[3 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes-E]'NNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes LJ No
❑ NA
❑ NE
Page 3 of 3 12128104

JO-Division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
- - - - - O Other Agency b1l
Type of Visit (),Crmpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit _101 outine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: I[�
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Time: ��GQ Departure Time: County: RegionG
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: /�/� /'l_ 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:
Latitude: = 0 O N Longitude: =° 0 I=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
JI ID Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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 -wade?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stacker
❑ Beef Feeder
❑ Beef Brood Cowl
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 VrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ,❑ No
❑ Yes
o
❑ NA
❑ NE
❑ Yes
[T0
❑ NA
❑ NE
12128104 Continued

-TFFacility Number' —d Date of inspection Z d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes )ZNo ❑ NA ❑ NE
❑ Yes V'No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [�No ❑ NA ❑ NE
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 P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ElNE
(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 PIN El ElNA El NE
maintenance or improvement? //
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes 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 Drifi ❑ 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 'VfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ff Na
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes �('No
El NA
[I NE
IT Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
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 Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El NA El 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ 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
ErNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P'No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
[INA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[IYes
o
ElNA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
ElYes
b 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
V(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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O'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?
❑Yesd(No
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
ICJ No
❑ NA
❑ NE
Additional Comments and/or Drawings: pp
12128104

.n Division of Water Quality
I M_ 2�� Facility Number O Division of Soil and Water Conservation
O 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: rrival Time: ! 3tJ Departure Time: County: Region:
Farm Name: v&r4'r"4ner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �A 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 No*
Integrator•
Operator Ce ' lcation Number:
Back-up Certification Number:
Latitude: ❑ o ❑ g = Longitude: 0 ° 0 ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ED
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

1'
i ~
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): Ko S
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 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
❑ 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 ft 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 lP�/� ��� Gr'L� ( Phone:
Reviewer/Inspector Signature: Date:
Page 2 af3 I I28104 Continued

r�
Facility Number: Date of Inspection
Rewired 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 ❑ Checklists ❑ Design ❑ Maps
p ❑ 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) and/or Drawings.
JComments
r?VRIS oQ
j u cQ Q_ lea
rece
d 62G,4ei"-a ll�tJ C>. s
ra(nA i 3 nCFZ)C S Cy
ar CW
Page 3 of 3 12128104

Type of Visit 9 Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit xRoutine O Complaint O Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 'QR Zg
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
ou nty:
Email:
te:
Region: �0
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = « Longitude: ❑ ° = .
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
11 J❑ Layer
E1 Non -La ei i
LJ Farrow to Wean '
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars - ---- — l
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 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
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
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 �fNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes oNo ❑ NA ❑ NE
12128104 Continued

A- t.
Facility Number: — Jr
Date of inspection I III �1G:5 1I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: /If r6f.5 3A 5 /"X 4
Spillway?: A42 D Np
Designed Freeboard (in): /L% 19,5-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes V No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes )z No ❑ NA ❑ NE
❑ Yes PO No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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 RINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of
Wind Drill ❑ Application Outside of Area
12. Crop type(s) �v1�f�T . �,460 '1)5 : 134.>/ 4110n+ 66"T 1541 co
13. Soiltype(s) 14y, A ISO, "oend#,4culK AL_f#OeN
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ¢ ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
7) , .5O,07f _*4 8A, A S 67.1 />7 /Y] Gip "-9A)
❑ Yes
No
❑ NA
❑ NE
No
❑ NA
ElNE
gNo
❑ NA
❑ NE
PrNo
❑ NA
❑ NE
ONo
El NA
El NE
Reviewer/Inspector Name I
_ s, . ., :
k Phone:
Reviewer/Inspector Signature: Date:
1.2128104 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 VrNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '0 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [A No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 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
Other issues
IffNE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P 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
:Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
JZ No
❑ NA
❑ NE
12128104

r '11vIS1olI of Water Quality
'- O,/D�iv�tsron_of Sod and Water Conservation _
.. » .,,»� - ,_ ..,. . - ,. _... sew"..,�.., . _ . n .. .. .:-_,-^- .7 , �, a �.:.,,.�. ,, •� �'�� -
� s
Type of Visit ,Compliance inspection O Operation Review O lagoon Evaluation
Reason for Visil A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Af
Facility Number Date of Visit: b 0 Tirge: 1
Not O erational O Below 'Threshold
Permitted Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name/....._ l!?.RTE....__._........_...... ._ — .... .W County: .._ LDJ _.....
OwnerName: ............................................ ............... ............... ............. .... . ................ Phone No:
mailingAddress:........._................................_........_.---- ..---------------------_
Facilitv Contact: ... - - ......., - - . W_ Title:.. ......... Phone No:
Onsite Representative:... M TqL, �.... Integrator:
Certified Operator:._........_.. .........._ .. .. _ ...._ . ----�— ._....... Operator Certification............._ ---
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 49 Longitude • 4 64
❑ Layer
TEO
Dairy
❑ Non -Layer
I
I
I ; da
❑ Non -Dairy
Discbarses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ffZNo
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)
El 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
❑ N
2. Is there evidence of past discharge from any part of the operation?
❑Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
[I Yes
�zo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure b
Identifier: ... .._.1 4.Lr............. ------- .........M M.........
Freeboard (inches): 3 q Zg 30
12112103
Continued

Facility Number: 31 - Date of inspection
15. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes UlKo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes L.i'No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes��No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [I Frozen Ground ❑ Copper and/or Zinc
12. Crop type CS(J T c SCv e W
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNT)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes �k0
b) Does the facility need a wettable acre determination? El Yes two
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes L�<-'
16. Is there a lack of adequate waste application equipment? ❑ Yes L.� No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes eNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �Wo�
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 o
Air Quality representative immediately.
r
Couuneints (refer to gtte on ) >Fatpta�n-any YFSµatiswtrs and/or any recommendatzoas or anv omen comments. = e'
Use drasviags, o!' #'acr`l�tty to better eai}tlam std�atioas.,(t�se atddttinnal pages as necessary} ,�<i t-t Field Copy ❑ Ftnal Note�`� ',
ScrLA pf:Cr� 6TW 1 - 6- wa u. COU Ck LO C) V6 G6-TA-rXfflJ
w(--
r �4
LJUP vPDA ) To ZEMOV6 6Cf—MV9A ADD M-ATUA ftE'Ck0J(—ES,
C� NET Gl✓� Ain nn � �EI�r- of 5�6 16.)a
-
Y
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
12112103 1 Continued

Facility Number: 3I _ 357 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified 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?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes
❑❑
No
❑ Yes No
Yes oNNo
❑ Yes El Yes
❑ Yes
El Yes
El Yes
es ❑ No
❑ Yes 7No,
<
❑ Yes
❑ Yes
❑ Yes jNo
❑ Yes
12112103

t�"ai
, Dtviston of Water`ty �sttinofSoianater Conservation „
r
Other'Agency: x
Type of Visit �& Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for VisitRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number bate of Visit: QZ Time:
rO Not Operational OBelowThreshold
M Permitted UCertified O Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: a 4el* 6 It_-'*- I_=5 ASt /✓&Ji 4 County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: / p Title: Phone No:
Onsite Representative: �i zL /L ra 9 Integrator: kc,4
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 " Longitude 0• ' 0�
Design Current Design Current Design Current
Swine Ca aelty Population Poultry Capacitv Population Cattle Capacitv Population
❑ Wean to Feeder 10 La er 1 10 Dairy
® Feeder to Finish / ❑ Non -Layer ❑ Non -Da'
❑ Farrow to Wean — -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds 1 Solid Traps
Subsurface Drains Present IILJ Lae000 Area
No Liquid W.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /} 2
Freeboard (inches): 3� _
0510310.1
❑ Yes [R-No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Ffo
❑ Yes XNo
❑ Yes C&No
Structure 6
Continued

Facility Number: 'T — 3571 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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes KNo
❑ Yes K No
❑ Yes X3 No
❑ Yes WO
❑ Yes [KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of over application? ❑ Excessive Pon/ding ❑ PAN
❑ Hydraulic Overload /� ❑ Yes RNo
12. Crop type A�t,A '* 1L ._ A�,z o&11^1 ��i�1.f//b-i'��t DLF'>el� C�41;
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [KNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes B 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
KNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
SNo
Reouired
Records & Documents
t 7.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
MNo
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
N No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
CO No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
F�LNo
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
O No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
El No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
® No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
men refer to question #) E_xplarn any YE5 answers,and/or any recommend attons,or any.other comments.-
ate 3h yr . a� �� r .'
Use drawrngs of factlity,to'better ezplam srtuahons ,use addraonal pages a`s necessary) [] Field Copy El Final Notes I
Aoar.' 5�`We neeh wvr4 4 y -,We -N�—'77we- Cr��
9
/c$' W11,h1&,f 2-4 "4?e1W'
H
Reviewer/inspector Name _;; '
...
Reviewer/Inspector Signature: Date: D
05103101 Continued

Facility Number: —3
Date of Inspection Printed
on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
INo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
FLNo
2$.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
4�TNo
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
[9 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
CBNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
CS No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
&No
5100

-19
NJ-
❑ Division of Soil and Water Conservation 0 Other Agency
N ® Division of Water Quality
Routine O Complaint O Follow-up of DW inspection O FoHow-up of DSWC review O Other
Date of Inspection
Facility Number 3 Time of Inspection Z` 24 hr. (hh:mm)
[3 Registered (A Certified 0 Applied for Permit [3 Permitted E3 Not Operational Date Last Operated: ..............
Farm Name: ........ WG:KrS 1&C .. 1-5 . 5� County: ............................................................
rr
Owner Name: ...........
�lJtt7.....1I''►ti'¢.........lCt�n..................................... Phone No:.. fe$.i.�i�...............................................
x,... I
FacilityContact: .d=- ............................ Title: ................................................ Phone No:........-........................................--
MailingAddress: .......1)..0........ &X...... ..�!.............................................................. ....[.4).kill...... 1_!.G..... .................. ............. ..����.........
Onsite Representative:.------.G&: Y.y.....�yL................................................................... Integrator: ...... X� m?�------••---........._...................-•---.........
Certified Operator; .......................... -1...................... ......... -.................................................. Operator Certification
Location of Farm:
Latitude =• =' t4 Longitude =' =' 0"
��Destgn Current QDesign Current Destga ;Current
*S�ne _ K n Capacity =Population Poultry ;CapacityPopulationCattle� Capacity PopulaEon�
❑Wean to Feeder,10Layer ❑ Dairy
u;
�] Feeder to Finish 3 72 is ❑ Non -Layer ❑Non-DairyF
Farrow to Wean
a Other r14
€ -
3 Farrow to Feederr
❑ Farrow to Finish s `Total Design Capacity
El Gilts
❑
Soars v� r x. �Tota15 r.
Number off Lagoons I�Holdtg Ponds ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
r ,: r`' r• ❑ No Liquid Waste Management System
Ilia-,
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? EP Yes ❑ No
Discharge originated at: ❑ Lagoon M Spray. Field ❑ Other
a. If discharge is observed, was the conveyance man-made? Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
taYes
❑ No
c. If discharge is observed, what is the estimated flow in sal/min?
I oc'd
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97 Continued on back

taciliVy Number:
8. Are there lagoons or storage ponds on site which need to be property closed? El Yes F4 No
Structures (Lagoons,11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? Yes 0 No
L_ -
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .............................. I .... .................................. I ................. I— ........... ... .. ................................... .................. .. ......
­1 ..........................
Freeboard (ft): .. ......... is, i ............ ................................ I ... ............. ...... .................................... .......................
...................................
10, Is seepage observed from any of the structures?
C:
El Yes
FA No
It. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
No
11. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'!
[I Yes
JR No
Waste Application
14. Is there physical evidence of over application?
QO Yes
El No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ............ 4scv ...................... 6m�Jr . ................................ r. ft.,a yoan ..........................................................
..........
I ...........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
C3 Yes
IM No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
D9 No
18. Does the receiving crop need improvement?
0 Yes
ES No
19. Is there a lack of available waste application equipment?
0 Yes
19 No
20. Does facility require a follow-up visit by same agency?
Yes
El No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
No
22. Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
C3 Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP'
❑ Yes
PNo
2.5. Were any additional problems noted which cause noncompliance of the Permit!
❑ Yes
0 No
0 No.viola'tions or de'flcien'cie's were 'noted during this. visit.- You will receive no further
s ofres'pondente about this. visit'-.','-.
.0
oinu6its'(ief.��to question '#):TxpIain'an � TSanswersFandlor any recofi m-'endatio'ns or any other
er,coidments
Use drawings offacility tiibetter explain situations pages as necessary) <p
I/A. Q&sA4004�%�Icejir�e1� ?vh UK_•ewv< xa r-Uy"O+
i&c
tip XO1+ V
C�-e Id V S"id be
ljooik O'"VCA'O, kv
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

IQ Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number
Date of Inspection q
,�
Time of inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: 'Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ... _ _ . _ __................._ ........ ...... .... .....» _.
FarmName: ........ _.».... _.............. _....... County:. Pat��.la�... ......... __ .....__..... �.[
Land Owner Name:Fv�......!�tj.L� Fg_............. Phone No:
Facility Conctact:... .....�~_tp.._q,... Title: Phone No: ... L9.! 0
Mailing Address:' Q.... �Sy.IL... .1....1........._......... ...._ .... ............................. ........
_ ....__..., . 5..
OnsiteRepresentative: ...... Q..�. _",Lsr..rxx�.atte�neIntegrator: M.azc.
Certified Operator ...... W........... _... ...... ................. ................ _............. ...... .. Operator Certification Number: _.�.. _ .. G} ..»... .
Location of Farm:
,._�?r �!�ar... �... ..�.....s.i. ......a .....�....1�..L._ ..t...a..�:�t:.x.:ur.!�,a.. .. ........�:a��..�d.._.�n,.o..r...�n..,e........_.. 4
:s n ears C.E A.a�...._sn.� Lam.... ..£ ..LI.L.$ :.. _ .... _ .... ...._ .... _..... _ ..... _...._......__....__...._._......_.... _..... y
Latitude FTT-16 SL 6 K Longitude ®• ����
Type of Operation and Design Capacity
€ , Design Curreisf v Design' Current s #I}essgn Current k
Swine.. _Foul Cattle
r: .. r Ca aci ,=rPo ulatton .n ._ Ca acity ...Po ulat�on r a.. .� .Ca ace ' . Pti ulhtion r:
❑ Wean to Feeder 10 La er ❑ D
der to Finish ( ;❑ Non -Layer
m Dairy
Farrow to Wean
-.,
V.
Farrow to Feeder 'Total Desk Capaetty< 0 w '�
Farrow to Finish~
El Other
Nu�be�r of Lag s I Hol��ng Ponds ❑ Subsurface Drains Present _
;s� ❑ Lagoon Area a� ❑Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation? .
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ® No
❑ Yes ji) No
❑ Yes ® No
❑ Yes No
❑ Yes I@ No
❑ Yes [j? No
❑ Yes I@ No
Yes ❑ No
Continued on back

Facility Number:..]...-•
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes g[No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes XNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes I%No
Structures (La;oons and/or Holding Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes &No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Z
10.
Is seepage observed from any of the structures?
❑ Yes
[allo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
KYes
❑ No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures Iack adequate minimum or maximum liquid level markers?
❑ Yes
KNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
RNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type �at'�r ^.at..4............�-t�S.k�► 4_ .... Spa �.:..i!Z.............................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management PIan (AWMP)?
❑ Yes
[.No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
IN No
18.
Does the receiving crop need improvement?
KYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
1KNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
2�No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONo
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
IffNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
24.
Does record keeping need improvement?
❑ Yes
R(No
Continents (refer to queshori Explain'an}r,,YES answeisyand/or any recommeiida ions or any other comments
ti
Use drawings of facility to'better explain srtuations :(use additional page as necessary) y
11. Lv t-Y W t..r d b .t , t tr-v-C 4 +n D v it �p 1 t I 06 vt
Le- I o- t o p cad ti i 0�4 i W q 111 a 1"
�o o �"� l o o ,n. i v�.ve-d �-a � C �+�--e�d• '�.n � I c� c..e� � � �. l °�
b c► y c w-�-r-e- o b S w-dL o h �� i ,...r..e.r c.► L l 1 s o b 9 t
w 1n i L ►ti eR io. e r e Vej 4- t 0. l
i S W o r i� C +' 4 co r r-t- C C f � i i t .S r '✓d-x! i-t iv` y� d C' 1 i f# L:#
Z+ w o.v � also be ar gadt i d-�t� tro g Fa- rir , 11; e_e, tT\_R_ cL; i-CA - b /a.-^ Y- b e.kl
l oovi 4Z. E+-vS�o a& tk;t lat;o<ff'on Cov4L Q,v.e„i.`-VC.L[�r ca�J4.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No..5 ! _ 3�
I` DIVISION OF ENVMON'YIENTAL MANAGEMENT
ANR AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: J-0 - � 1995
Time: 1 0 ' o
Fanr, Name/Owner: W -v-v urs 1 112 L jO�-nn 2Pt'Q - -
Mailing Address: _
County: — ---�
Litegator: I UI-06(9
On Site Representative:
Physic7d Address/Location:
� T3 2r r.e
� 7 � 3 �rr►i n�sf
54 ;
Phone:
Phone:
o f erseC�on I[ P S
Type of Operation: Swine ,Z Poultry Cattle
Design Capacity: L�ia �_ Number of Animals on Site: S�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Ladrude: Z 'VI Longitude: ' 03 ' SS.4b' Elevation:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot - 25 year 24 hour storm event
(approximately 1 Foot T 7 inches) Yes r No Actual Freeboard: _a -Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? &r No
48 Is adequate land available for spray? Yes or No Is the cover crop adequate?. Yes or No
rr�p(s; being utilized:
Do;.s the facility me,-,, SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? Oor No
Es the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes d N
Is aninial waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing sv_ stem, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied.,
spray irrigated on specific acreage with cover crop) . Yes r No
Additional Comments: _M ► po , efcr.'aDn - bwe 5 (vpe 5
. Inspector Name Si
cc; FacillLy Assessment Unit Us,- Anachments if Needcd.

Site Requires Immediate Attention-.
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ` cl _, 1995
Time:
Farm Name/Owner: erS 22 4~'t 5 t3
Mailing Address: SXS &11h ?ter
County: _ Duo("() - - - -
Integrator. _ - �iL�rli�l_ Phone:
On Site Representative: I _ Prone:
Physical Address/Location: SI-111-7 of�l Cr. 614
Type of Operarion: Swine L"-- Poultry Cattle
Design Capacity: Number of Animals on Site: 3-2 S v
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 ' S2- ' .15" Longitude: -)q ' C7'� 'S2.03' Elevation: _ Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot _ 25 year 24 hour storm event
(approximately 1 Foot + i inches) Yes r No Actual Freeboard: _ Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
• Is adequate land available for spray? Y e or No Is the cover crop adequate? Yes o No
2 l_
Crop(s) being utilized: f2 o c2 hnn 2blr
e -G roo •
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwe=lings?oor No
100 Feet from R e:ls?. Yes or No
Is the animal waste stockpiled within 100 Feet of liSGS Blue Line Stream? Yes o Ne
Is animal waste land applied or spray irrigated within 25 Feet of a liSGS Ian Blue Line? Yes o ! o
Is animal waste discharged into waters of the state by man-made di.tc:, flushing system. or other
similar man-made devices? Yes o& If Yes, Please E:cp•ia r.
a.
Does the facility maintain adequate waste management records (vohi Yzs ofmanure, land applied,
spray irrigated on specific acreage with cover crop)? 5017 No
Additional Comments: nJ e —_ 6nCUr_ �+ On
Ae_CJ 5 V Q z c)^ .
L. Ls
Inspector Name
cc: Faclht'v Assessrntnc.Unit
AeL
Signature
Us-- Auachm,] ,ts if Net-dtd.